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Occult pneumococcal bacteremia: a review.
Mark D Joffe1, Elizabeth R Alpern
1Community Pediatric Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA. joffe@email.chop.edu
Pediatric Emergency Care
|June 10, 2010
Summary
Occult pneumococcal bacteremia in children is decreasing due to vaccines. Current consensus favors no testing or treatment for well-appearing, immunized febrile children, addressing antibiotic resistance concerns.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Vaccinology
Background:
- Occult bacteremia, primarily caused by Streptococcus pneumoniae, has been a significant clinical controversy in pediatric emergency medicine.
- The epidemiology of occult bacteremia has been rapidly altered by vaccine development and widespread immunization programs.
- Antibiotic resistance presents a growing challenge in managing pediatric infections.
Purpose of the Study:
- To review the current knowledge and clinical practices regarding occult pneumococcal bacteremia.
- To provide historical context for the phenomenon of occult bacteremia.
- To discuss the evolving consensus on testing and treatment strategies for febrile children.
Main Methods:
- Literature review of occult pneumococcal bacteremia.
- Analysis of epidemiological data influenced by vaccination.
- Discussion of clinical controversies and expert opinions.
Main Results:
- Vaccine development, including Haemophilus influenzae type B (Hib) and pneumococcal conjugate vaccine (PCV-7), has significantly reduced the incidence of occult bacteremia.
- A growing consensus supports withholding testing and treatment for well-appearing, febrile children aged 6-36 months who are appropriately immunized.
- This approach addresses concerns about antibiotic resistance and the declining incidence of the disease.
Conclusions:
- The changing epidemiology due to vaccination supports a shift in clinical practice for managing febrile children.
- No testing and no treatment is increasingly favored for specific, well-appearing, immunized pediatric populations.
- Understanding the historical context and current evidence is crucial for informed clinical decision-making regarding occult pneumococcal bacteremia.
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