Low risk of bacteremia in children with febrile seizures
Samir S Shah1, Elizabeth R Alpern, Lisa Zwerling
1Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. shahs@email.chop.edu
Insights
Children aged 2 to 24 months with febrile seizures have a low risk of bacteremia, similar to those with fever alone. The pneumococcal conjugate vaccine may further reduce this risk.
Area of Science:
- Pediatrics
- Infectious Diseases
- Epidemiology
Background:
- Febrile seizures are common in children.
- Occult bacteremia, or bacteria in the bloodstream without an obvious source, is a concern in febrile children.
- Understanding the risk of bacteremia in children with febrile seizures is crucial for appropriate management.
Purpose of the Study:
- To determine the incidence of bacteremia in young children (2-24 months) presenting with febrile seizures.
- To compare the risk of bacteremia in this group to children with fever alone.
Main Methods:
- Retrospective cohort study of 379 children aged 2 to 24 months.
- Data collected from an urban tertiary care children's hospital emergency department.
- Analysis of bacteremia rates and causative organisms.
Main Results:
- Bacteremia occurred in 2.1% of children with febrile seizures.
- Streptococcus pneumoniae was the most common pathogen.
- No bacteremia was observed in children who received antibiotics prior to evaluation.
- Most S. pneumoniae isolates were preventable by the pneumococcal conjugate vaccine.
Conclusions:
- Children aged 2 to 24 months with febrile seizures have a low risk of occult bacteremia.
- The risk appears similar to that of children with fever alone.
- Widespread use of the pneumococcal conjugate vaccine is expected to further decrease bacteremia incidence in this population.
Objective:
To evaluate the risk of bacteremia in children with febrile seizures treated as outpatients.
Methods:
A retrospective cohort study was performed involving 379 children aged 2 to 24 months presenting to an urban tertiary care children's hospital emergency department with a febrile seizure between February 1, 1993, and May 31, 1996.
Results:
The mean patient age was 15.9 months, and 217 (57%) were male. In 40 patients (10.6%), the use of oral antibiotics before initial emergency department evaluation was reported. Bacteremia occurred in 8 (2.1%) of 379 children studied. None of the children with bacteremia had received previous antibiotics. The causative organisms were Streptococcus pneumoniae in 7 cases and group A Streptococcus in 1 case. There were 5 contaminated cultures (1.3%). Although 2 of the 8 children with bacteremia ultimately required admission, there were no serious adverse outcomes. Six of 7 episodes of S pneumoniae bacteremia were caused by serotypes included in the pneumococcal conjugate vaccine, which was not available at the time of this study.
Conclusions:
Children 2 to 24 months of age with febrile seizures are at similar risk for occult bacteremia as those with fever alone. Widespread use of the pneumococcal conjugate vaccine may further decrease the incidence of bacteremia in this population.
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