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A comparative study of the prevalence, outcome, and prediction of bacteremia in children
Insights
Routine blood cultures are unnecessary for febrile infants receiving antibiotics, as prevalence and predictability of bacteremia did not differ across diverse settings. Outcomes were generally uncomplicated, suggesting current practices may be overutilized.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Microbiology
Background:
- Bacteremia in febrile infants presents a diagnostic challenge.
- Understanding prevalence and predictability across different socioeconomic and clinical settings is crucial for optimizing management.
Purpose of the Study:
- To compare the prevalence, predictability, and outcomes of bacteremia in young children (3-24 months) with high fevers across diverse clinical settings.
- To evaluate the necessity of routine blood cultures in this population.
Main Methods:
- Prospective, concurrent comparison of bacteremia in infants across an inner-city hospital, a suburban hospital, and private pediatric offices.
- Data collected on patient demographics, clinical presentation, treatment, and outcomes.
Main Results:
- Bacteremia prevalence (3.1%–7.4%) and predictability did not significantly differ among the three study groups.
- No racial, geographic, or socioeconomic predilection for bacteremia was observed.
- Most bacteremic outpatients received antibiotics; one developed meningitis, while others had uncomplicated courses.
Conclusions:
- Routine blood cultures are not necessary for all highly febrile infants who are prescribed antibiotics.
- Current diagnostic and management strategies for febrile infants may not require routine blood cultures in all cases.
Abstract:
We undertook a prospective, concurrent comparison of the prevalence, predictability, and outcome of bacteremia in children from 3 to 24 months of age with temperatures greater than or equal to 39.5 degrees C in three diverse clinical settings: primarily black lower-class children at an inner-city hospital (n = 532), primarily white middle-class children at a suburban hospital (n = 160), and primarily white middle-class children in offices of pediatricians in private practice (n = 94). The prevalence of bacteremia for the entire study sample (3.1% to 7.4%) and outpatients only (1.9% to 5.9%) was not statistically different among the three groups. There were no statistically significant differences among the three groups in identifying children with bacteremia (P greater than 0.05). There was no racial, geographic, or socioeconomic predilection for bacteremia in infants. At the first visit, antibiotics were prescribed (most commonly for otitis media) for 23 of the 25 bacteremic patients who were not initially hospitalized. One patient with otitis media developed meningitis. The others had uncomplicated courses and were well by 96 hours (most by 48 hours). In office settings, private practitioners were no better in predicting bacteremia in familiar patients than they were with first-time patients. Information from blood culture did not appear to alter patient management. We conclude, therefore, that routine blood cultures are unnecessary for all highly febrile infants given antibiotics.