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Occult Bacteremia: Should We Look for the Needle in the Haystack?
Neta Baram1, Orli Megged1, Giora Weiser2
1Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
Occult bacteremia (OB) is now rare in children vaccinated with the pneumococcal conjugate vaccine (PCV). This study found no complications in the few cases identified, with changing serotypes observed.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Occult bacteremia (OB) incidence has significantly decreased due to widespread vaccination with Haemophilus influenzae type B and pneumococcal conjugate vaccines (PCV).
- Current guidelines increasingly recommend against blood cultures in fully vaccinated febrile children.
- PCV13 introduction is now prevalent in Israel.
Purpose of the Study:
- To determine the incidence and outcomes of OB caused by Streptococcus pneumoniae.
- To evaluate OB in a large pediatric medical center.
Main Methods:
- Retrospective review of pneumococcal bacteremia cases from 2008-2013.
- Focused analysis on cases identified as occult bacteremia.
Main Results:
- Out of 355 bacteremia cases, 164 were due to S. pneumoniae, with 20 (12.8%) classified as occult.
- No complications were observed in any occult bacteremia cases.
- Occult bacteremia was not diagnosed in children older than 36 months, and serotype distribution shifted.
Conclusions:
- Occult bacteremia is infrequent in the PCV-vaccinated pediatric population.
- The serotypes responsible for pneumococcal occult bacteremia have evolved.
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