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Background  There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital.    Methods  We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for  Rickettsia typhi .    Results  Putative etiological agents for fever were identified in 164 (15%) patients.  Salmonella enterica  serovar Typhi ( S.  Typhi) was identified in 107 (10%),  S. enterica  serovar Paratyphi A ( S.  Paratyphi) in 30 (3%),  Streptococcus pneumoniae  in 6 (0.6%),  S. enterica  serovar Typhimurium in 2 (0.2%),  Haemophilus influenzae  type b in 1 (0.1%), and  Escherichia coli  in 1 (0.1%) patient.  S.  Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for  R. typhi.  No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus.    Conclusions  Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

Bloodstream Infection among Children Presenting to a General Hospital Outpatient Clinic in Urban Nepal