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Published on: October 15, 2014
Should blood cultures be obtained in all infants 3 to 36 months presenting with significant fever?
David I Rappaport1, David Cooperberg, Jonathan Fliegel
1Thomas Jefferson University and Nemours/AI duPont Hospital for Children.
Insights
For febrile children aged 3-36 months with no source of fever, blood cultures may not be necessary. Recent literature indicates a low bacteremia rate (<1%) in non-toxic children, suggesting a potential change in clinical practice.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Fever without source (FWS) is a frequent pediatric presentation in children aged 3-36 months.
- Evolving immunization practices necessitate re-evaluation of older guidelines for managing FWS.
- The utility of blood cultures in this demographic requires updated evidence.
Purpose of the Study:
- To review existing literature on the necessity of blood cultures for non-toxic children aged 3-36 months presenting with FWS.
- To assess current bacteremia rates in this specific pediatric population.
Main Methods:
- A comprehensive MEDLINE literature search was performed.
- The search focused on bacteremia in febrile children aged 3-36 months, covering publications from 2004 to the present.
- Eight relevant studies were identified and included in the review.
Main Results:
- All included studies indicated a bacteremia rate below 1% in non-toxic, febrile children aged 3-36 months.
- Despite variations in study methodologies, the findings consistently pointed to a low incidence of bacteremia.
- This suggests a low risk of serious bacterial infection in this patient group.
Conclusions:
- For non-toxic children aged 3-36 months with FWS, foregoing blood cultures warrants strong consideration.
- The low reported bacteremia rates support a less invasive diagnostic approach.
- Clinical practice guidelines may need revision based on current evidence regarding FWS management.
Context:
Fever without source (FWS) in children 3-36 months is a common presenting complaint. Because of changes in immunization practices and their effects on rates of bacteremia, older guidelines may no longer be applicable. We reviewed the literature regarding the necessity of obtaining a blood culture in non-toxic children in this age group with FWS.
Data Sources:
We conducted a MEDLINE search on the topic of bacteremia in febrile children 3-36 months from 2004-present.
Results:
Eight studies were included. Although the studies varied in terms of approach and analysis, all suggested a rate of bacteremia in a non-toxic, febrile child 3-36 months of age to be less than 1%.
Conclusions:
Strong consideration should be given for foregoing blood culture in a non-toxic child 3-36 months of age with FWS.
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