Bacteremia in Children With Fever and Acute Lower Extremity Pain

Area of Science:

• Pediatrics
• Infectious Diseases
• Emergency Medicine

Background:

• Blood cultures (BCxs) are common in evaluating febrile children with lower extremity pain.
• The diagnostic yield of BCxs in this specific pediatric population is not well-established.

Purpose of the Study:

• To determine the prevalence of bacteremia in children presenting to the emergency department (ED) with fever and acute lower extremity pain.
• To identify clinical predictors associated with bacteremia in this cohort.

Main Methods:

• A cross-sectional review of 689 children (aged 1-18 years) presenting to the ED with fever and acute lower extremity pain between 2010-2020.
• Exclusion criteria included recent trauma, orthopedic comorbidities, immunocompromised status, or prior antibiotic use.
• Data were extracted using a Natural Language Processing-assisted model with manual review; the primary outcome was a pathogen-positive BCx.

Main Results:

• Bacteremia was detected in 10.2% of the entire cohort (70/689 children).
• The most frequent pathogens identified were methicillin-susceptible Staphylococcus aureus (71.6%) and methicillin-resistant Staphylococcus aureus (15.7%).
• Predictors of bacteremia included elevated C-reactive protein (≥3 mg/dL) and localizing examination findings.

Conclusions:

• The prevalence of bacteremia in children with fever and acute lower extremity pain is significant.
• Routine blood cultures are recommended for the initial evaluation of these pediatric patients.