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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
PubMed

Insights

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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