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Children with Haemophilus influenzae bacteremia initially treated as outpatients: outcome in 85 American Indian
M M Cortese1, J Goepp, J Almeido-Hill
1Department of International Health, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205.
Insights
Outpatient treatment for Haemophilus influenzae bacteremia in children can lead to new infections, including meningitis, within days. Close medical follow-up is crucial for all children diagnosed with this bloodstream infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Haemophilus influenzae bacteremia is a serious infection in children.
- Outpatient management is increasingly common for certain pediatric infections.
- Predictors of adverse outcomes in children treated as outpatients for bacteremia require further investigation.
Purpose of the Study:
- To determine the incidence of new infectious foci in American Indian children treated as outpatients for Haemophilus influenzae bacteremia.
- To identify the time interval to the development of new foci.
- To assess if age or temperature at presentation predict outcomes in this population.
Main Methods:
- Retrospective chart review of 85 American Indian children under 16 with H. influenzae bacteremia.
- Analysis of initial presentation, treatment, and follow-up data.
- Assessment for development of new infectious foci and hospitalization status.
Main Results:
- 58% of children were never hospitalized, but 29% developed new foci, including 15% with meningitis.
- New foci were identified within 6 days of initial presentation (median 2 days).
- Age and temperature at presentation did not predict outcomes.
Conclusions:
- A significant proportion of children with H. influenzae bacteremia treated as outpatients developed complications.
- Prompt reevaluation and close follow-up are essential for all children with H. influenzae bacteremia.
- Outpatient management requires careful monitoring for evolving clinical signs.
Abstract:
Eighty-five American Indian children less than 16 years of age with Haemophilus influenzae bacteremia were retrospectively determined to have been treated as outpatients after their initial evaluation. We hoped to determine the proportion that developed new foci, the time interval to this development and whether age or temperature at presentation predicted outcome. Fifty-one (60%) presented with nonfocal findings. Seventy-two (85%) were treated with antibiotics at the initial visit. Although 49 (58%) of the patients were never hospitalized, a new focus was identified in 25 (29%), including 13 (15%) with a final diagnosis of meningitis. The new foci were identified within 6 days of presentation (median, 2 days). An additional 15 (18%) patients had no new focus but were febrile and/or ill at follow-up. All patients with meningitis or a second positive culture were hospitalized at the first follow-up visit. Age and temperature at presentation did not help predict outcome. All patients with H. influenzae bacteremia require prompt reevaluation and close follow-up by an experienced physician.