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Effect of antibiotic therapy on the outcome of outpatients with unsuspected bacteremia
M B Harper1, R Bachur, G R Fleisher
1Division of Emergency Medicine, Children's Hospital, Boston, MA 02115, USA.
Insights
Children with unsuspected bacteremia, particularly Streptococcus pneumoniae, who did not receive antibiotics initially were more likely to have worse outcomes. Prompt antibiotic treatment, especially parenteral, is crucial for better recovery and preventing persistent infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Unsuspected bacteremia in children presents a diagnostic challenge.
- Streptococcus pneumoniae is a common cause of bacteremia in pediatric outpatients.
- The optimal management strategy for occult bacteremia remains an area of investigation.
Purpose of the Study:
- To evaluate the clinical outcomes of children with unsuspected bacteremia based on initial antibiotic management.
- To compare the effectiveness of no antibiotics, oral antibiotics, and parenteral antibiotics in treating pediatric bacteremia.
Main Methods:
- Retrospective review of 559 outpatient children with unsuspected bacteremia.
- Comparison of outcomes including improvement, fever, hospitalization, persistent bacteremia, and new focal infections.
- Subgroup analysis for Streptococcus pneumoniae and occult bacteremia.
Main Results:
- Children receiving no antibiotics had significantly worse outcomes: less improvement (32% vs. 86%), more fever (75% vs. 28%), higher hospitalization rates (67% vs. 22%), persistent bacteremia (28% vs. 3%), and new infections (13% vs. 5%).
- Oral antibiotics were associated with less improvement (81% vs. 89%) and more persistent bacteremia (5% vs. 0%) compared to parenteral antibiotics.
- Parenteral antibiotic therapy at the initial visit resulted in no positive blood or spinal fluid cultures at follow-up.
Conclusions:
- Initial antibiotic treatment, particularly parenteral, is associated with improved outcomes in children with unsuspected bacteremia.
- Delaying antibiotic treatment or opting for oral therapy may lead to poorer clinical responses and persistent infections.
- Parenteral antibiotics appear most effective in eradicating bacteremia and preventing complications.
Abstract:
The records of 559 consecutive outpatient children with unsuspected bacteremia (467 Streptococcus pneumoniae) were reviewed. When compared with patients receiving oral or parenteral antibiotics, those patients who received no antibiotics at the initial visit were in follow-up: (1) less likely to be improved (32% vs. 86%, P < 0.01); (2) more likely to be febrile (75% vs. 28%, P < 0.01); (3) more likely to be hospitalized (67% vs. 22%, P < 0.01); (4) more likely to have persistent bacteremia (28% vs. 3%, P < 0.01); and (5) more likely to have new focal infections (13% vs. 5%, P < 0.01). Compared with patients receiving parenteral antibiotics at the initial visit, patients receiving oral antibiotics were in follow-up: (1) less likely to be improved (81% vs. 89%, P < 0.05); and (2) more likely to have persistent bacteremia (5% vs. 0%, P < 0.05). There was no statistical difference between patients receiving parenteral or oral therapy in the development of focal infections, although children with new focal infections receiving oral antibiotics more often had persistent or new positive cultures. No patients receiving parenteral antibiotics at the initial visit had positive blood or spinal fluid cultures at the follow-up visit. Analyses of the subgroups with (1) occult bacteremia with all organisms, (2) unsuspected bacteremia S. pneumoniae and (3) occult bacteremia with S. pneumoniae show results similar to those for the entire group.(ABSTRACT TRUNCATED AT 250 WORDS)