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Prevalence of Occult Bacteremia in Children Aged 3 to 36 Months Presenting to the Emergency Department with Fever in the Postpneumococcal Conjugate Vaccine Era
Author(s) -
Wilkinson Matthew,
Bulloch Blake,
Smith Matthew
Publication year - 2009
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2008.00328.x
Subject(s) - medicine , emergency department , bacteremia , blood culture , confidence interval , pneumococcal conjugate vaccine , streptococcus pneumoniae , pediatrics , occult , cohort , antibiotics , alternative medicine , pathology , psychiatry , microbiology and biotechnology , biology
Objectives: The goal of this study was to identify the prevalence of occult bacteremia (OB) in well‐appearing, previously healthy children aged 3 to 36 months who present to the emergency department (ED) with fever without source in the post–pneumococcal conjugate vaccine (PCV) era. Methods: This was a retrospective cohort study of children presenting to an urban pediatric ED between July 1, 2004, and June 30, 2007. Children were included if they were aged 3 to 36 months, febrile, and previously healthy; had no source of infection on examination; had a blood culture drawn; and were discharged from the ED. Outcome measures were rates of OB and contaminant rates. Results: A total of 8,408 children met all inclusion criteria. There were 21 true‐positives, yielding an OB rate of 0.25% (95% confidence interval [CI] = 0.16% to 0.37%). There were 159 contaminant cultures yielding a contaminant rate of 1.89% (95% CI = 1.61% to 2.19%), or a ratio of 7.6 contaminants for each true‐positive. There were 14 included patients who grew Streptococcus pneumoniae from the blood, for a rate of 0.17% (95% CI = 0.09% to 0.27%). Conclusions: Given the current rate of OB in the post‐PCV era, it may no longer be cost‐effective to send blood cultures on well‐appearing, previously healthy children aged 3 to 36 months who have fever without source.