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Published on: November 16, 2016
Outcome of children with occult bacteremia caused by Haemophilus influenzae type b
D N Korones1, G S Marshall, E D Shapiro
1Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
Insights
Children with occult Haemophilus influenzae type b (Hib) bacteremia managed as outpatients face risks for serious infections. Younger children and those not receiving susceptible antimicrobials showed higher risks, highlighting the need for careful monitoring.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Occult bacteremia in children, particularly Haemophilus influenzae type b (Hib), presents diagnostic and management challenges.
- Understanding the clinical course and outcomes of Hib bacteremia in outpatient settings is crucial for pediatric care.
Purpose of the Study:
- To define the clinical course and outcomes of children with occult Haemophilus influenzae type b bacteremia initially managed as outpatients.
- To identify risk factors for developing serious focal infections in this pediatric population.
Main Methods:
- Retrospective review of medical records of 69 children with occult Hib bacteremia managed as outpatients.
- Data collection included patient demographics, clinical presentation, treatment, and follow-up outcomes.
- Statistical analysis compared outcomes between different patient subgroups.
Main Results:
- 52% of children developed serious focal infections (meningitis, pneumonia, epiglottitis, etc.) upon follow-up.
- 48% appeared well initially, but 8 (24%) later developed focal infections or remained bacteremic.
- Younger children (median age 8.5 months) were at higher risk for subsequent infections compared to older children (median age 16 months).
- Antimicrobial treatment susceptibility did not significantly impact outcomes (P=0.17).
Conclusions:
- Children initially managed as outpatients with occult Hib bacteremia are at significant risk for developing serious focal infections.
- Age appears to be a critical factor in predicting outcomes, with younger children being more vulnerable.
- Close monitoring and prompt management are essential for children diagnosed with occult Hib bacteremia.
Abstract:
For better definition of the clinical course and outcome of children with occult bacteremia caused by Haemophilus influenzae type b (Hib), we reviewed the medical records of children who were initially managed as outpatients and subsequently found to be bacteremic. At Yale-New Haven Hospital (1971 to 1987) and the Children's Hospital of Philadelphia (1982 to 1987), 69 previously healthy children were identified with occult Hib bacteremia. Their median age was 14 months (range, 4 to 89 months). Thirty-six (52%) of the 69 were either febrile and/or had a focus of serious infection at follow-up (meningitis (17), pneumonia (5), epiglottitis (3), cellulitis (5), and septic arthritis (3)). Although the remaining 33 children (48%) were afebrile and appeared well on reevaluation, 3 of these 33 were still bacteremic and another 5 subsequently developed focal Hib infections. These 8 children were significantly younger (median age, 8.5 months) than the 25 children who remained well (median age, 16 months; P = 0.03). Of the 28 children who had initially been treated with antimicrobials to which their organism was known to be susceptible, 12 (43%) were improved at reevaluation and remained well; 7 (23%) of the 31 patients who had not received such antimicrobials improved and remained well (P = 0.17). Children initially managed as outpatients and later found to have had Hib bacteremia are at risk of subsequently developing a serious focal infection.
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