The rate of occult bacteremia in infants 3 months to 24 months with a temperature higher than 40.5C was slightly higher when compared to those with a temperature higher than 39C.
363 infants (3 months to 24 months) with a fever > 40.5C who were well appearing were evaluated in this study. 4 were diagnosed with occult bacteremia (1.1%). 3 of these were caused by S. pneumoniae and 2 were fully immunized.
A larger sample size is needed to see if reconditions to include empiric blood cultures on this subgroup of patients is warrented.
Answer
After introduction of the pneumococcal conjugate vaccine, occult bacteremia dramatically decreased.Previous cost effective analysis showed that if the rate of occult bacteremia was less than 0.5%, then empiric testing should be eliminated, but if it is over 1.5%, then obtaining blood work is cost effective.In vaccinated patients, the occult bacteremia rates is less than 0.5%.These studies that showed this included patients with temperatures > 39C.This study looked at higher temperatures to see if there was a higher rate of occult bacteremia in this subgroup. In this ED, in all children with a temperature > 40.5C it was recommended that patients get a blood culture, WBC, ANC, CRP, UA, procalcitonin and PCR for pneumococcus and meningococcus regardless of immunization status.Further testing was at the discretion of the physician.
References
Gangoiti et al.Prevalence of Occult Bacteremia in Infants with Very High Fever without a source. Pediatr Infect Dis J. 2018 Feb.epub ahead of print.
