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Occult Bacteremia in Young Children with Very High Fever Without a Source: A Multicenter Study

Iker Gangoiti1, Ane Zubizarreta, Borja Elgoibar

  • 1Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain.

The Pediatric Infectious Disease Journal
|September 8, 2020
PubMed

Insights

High fever in young children may indicate serious bacterial infection. Consider testing for occult bacteremia in children aged 3-24 months with fever without a source of at least 40.5°C.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Clinical Microbiology

Background:

  • Fever without a source is common in young children.
  • Identifying serious bacterial infections (SBIs) early is crucial for appropriate management.
  • High-grade fevers (≥40.5°C) may warrant closer investigation.

Purpose of the Study:

  • To determine the incidence of SBI and bacteremia in previously healthy children aged 3-24 months presenting with high fever (≥40.5°C) without an apparent source.
  • To evaluate the utility of testing for occult bacteremia in this specific pediatric population.

Main Methods:

  • Prospective, multicenter study design.
  • Inclusion of 203 well-appearing, previously healthy children aged 3-24 months with fever without a source ≥40.5°C.
  • Diagnostic workup including blood cultures to identify bacteremia and other tests for SBI.

Main Results:

  • Serious bacterial infection (SBI) was diagnosed in 15.3% of children (95% CI 11.0-20.9).
  • Bacteremia was identified in 3% of children (95% CI 1.4-6.3).
  • The incidence of SBI and bacteremia was significant in this cohort.

Conclusions:

  • Testing for occult bacteremia should be considered in children aged 3-24 months presenting with fever without a source of ≥40.5°C.
  • High-grade fever in this age group is associated with a notable risk of SBI.
  • These findings support a cautious approach to fever without a source in young children.

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