PEDIATRICS Vol. 57 No. 6 June 1976, pp. 861-868
This Article
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by McCarthy, P. L.
Right arrow Articles by Dolan, T. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by McCarthy, P. L.
Right arrow Articles by Dolan, T. F., Jr.

Bacteremia in Children: An Outpatient Clinical Review

Paul L. McCarthy M.D.1, Gordon W. Grundy M.D.1, Sydney Z. Spiesel M.D.1, and Thomas F. Dolan Jr. M.D.1

1 Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut

In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia. Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b. Ninety-three percent of children with H. influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit. Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea. In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion.

Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially.

Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease. A temperature of ge 40.5 C showed more specificity for bacteremia than lesser fevers. A white blood cell count > 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures.

Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid.

Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement. This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated.

Submitted on May 19, 1975
Accepted on October 14, 1975




This article has been cited by other articles:


Home page
 Arch. Dis. Child. Fetal Neonatal Ed.Home page
A Martin-Ancel, A Garcia-Alix, S Salas, F del Castillo, F Cabanas, and J Quero
Cerebrospinal fluid leucocyte counts in healthy neonates
Arch. Dis. Child. Fetal Neonatal Ed., September 1, 2006; 91(5): F357 - F358.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
J. R. Serwint, M. M. Dias, H. Chang, M. Sharkey, and A. R. Walker
Outcomes of Febrile Children Presumed to be Immunocompetent Who Present with Leukopenia or Neutropenia to an Ambulatory Setting
Clinical Pediatrics, September 1, 2005; 44(7): 593 - 600.
[Abstract] [PDF]

Home page
 Eval Health ProfHome page
E. D. Cox, M. A. Smith, and J. M. Bartell
Managing Febrile Infants: Impact of Literature Recommendations Published During a Physician's Residency
Eval Health Prof, September 1, 2005; 28(3): 328 - 348.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
J. R. Casey, S. M. Marsocci, M. L. Murphy, A. B. Francis, and M. E. Pichichero
White Blood Cell Count Can Aid Judicious Antibiotic Prescribing in Acute Upper Respiratory Infections in Children
Clinical Pediatrics, March 1, 2003; 42(2): 113 - 119.
[Abstract] [PDF]

Home page
 PediatricsHome page
G. M. Lee, G. R. Fleisher, and M. B. Harper
Management of Febrile Children in the Age of the Conjugate Pneumococcal Vaccine: A Cost-Effectiveness Analysis
Pediatrics, October 1, 2001; 108(4): 835 - 844.
[Abstract] [Full Text] [PDF]

Home page
 Fam PractHome page
D Dabelstein and B Cromer
Recent advances in conjugated pneumococcal vaccination
Fam. Pract., October 1, 2000; 17(5): 435 - 441.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
E. R. Alpern, E. A. Alessandrini, L. M. Bell, K. N. Shaw, and K. L. McGowan
Occult Bacteremia From a Pediatric Emergency Department: Current Prevalence, Time to Detection, and Outcome
Pediatrics, September 1, 2000; 106(3): 505 - 511.
[Abstract] [Full Text]

Home page
 PediatricsHome page
R. Bachur and M. B. Harper
Reevaluation of Outpatients With Streptococcus pneumoniae Bacteremia
Pediatrics, March 1, 2000; 105(3): 502 - 509.
[Abstract] [Full Text]

Home page
 Arch Intern MedHome page
K. I. Plaisance and P. A. Mackowiak
Antipyretic Therapy: Physiologic Rationale, Diagnostic Implications, and Clinical Consequences
Arch Intern Med, February 28, 2000; 160(4): 449 - 456.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
R. T. Strait, K. J. Kelly, and V. P. Kurup
Tumor Necrosis Factor-alpha , Interleukin-1beta , and Interleukin-6 Levels in Febrile, Young Children With and Without Occult Bacteremia
Pediatrics, December 1, 1999; 104(6): 1321 - 1326.
[Abstract] [Full Text]

Home page
 Arch Pediatr Adolesc MedHome page
N. Kuppermann and E. A. Walton
Immature Neutrophils in the Blood Smears of Young Febrile Children
Arch Pediatr Adolesc Med, March 1, 1999; 153(3): 261 - 266.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
N. Kuppermann, R. Malley, S. H. Inkelis, and G. R. Fleisher
Clinical and Hematologic Features Do Not Reliably Identify Children With Unsuspected Meningococcal Disease
Pediatrics, February 1, 1999; 103(2): 20e - 20.
[Abstract] [Full Text]

Home page
 Ann. N. Y. Acad. Sci.Home page
P. A. MACKOWIAK and K. I. PLAISACNE
Benefits and Risks of Antipyretic Therapy
Ann. N.Y. Acad. Sci., September 29, 1998; 856(1): 214 - 223.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
G. M. Lee and M. B. Harper
Risk of Bacteremia for Febrile Young Children in the Post-Haemophilus influenzae Type b Era
Arch Pediatr Adolesc Med, July 1, 1998; 152(7): 624 - 628.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
S. G. Rothrock, M. B. Harper, S. M Green, M. C. Clark, R. Bachur, D. P. McIlmail, P. A. Giordano, and J. L. Falk
Do Oral Antibiotics Prevent Meningitis and Serious Bacterial Infections in Children With Streptococcus pneumoniae Occult Bacteremia? A Meta-analysis
Pediatrics, March 1, 1997; 99(3): 438 - 444.
[Abstract] [Full Text] [PDF]

Home page
 CLIN PEDIATRHome page
G. A. Meyer, T. R. Shope, N. J. Waecker JR, and F. H. Lanningham
Moraxella (Branhamella) Catarrhalis Bacteremia in Children: A Report of Two Patients and Review of the Literature
Clinical Pediatrics, March 1, 1995; 34(3): 146 - 150.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
W. A. Bonadio, K. McElroy, P. L. Jacoby, and D. Smith
Relationship of Fever Magnitude to Rate of Serious Bacterial infections in Infants Aged 4-8 Weeks
Clinical Pediatrics, August 1, 1991; 30(8): 478 - 480.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
J. M. Leventhal
Clinical Predictors of Pneumonia As a Guide to Ordering Chest Roentgenograms
Clinical Pediatrics, December 1, 1982; 21(12): 730 - 734.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
R. H. Schwartz and R. L. Wientzen JR
Occult Bacteremia in Toxic-appearing, Febrile Infants: A Prospective Clinical Study in an Office Setting
Clinical Pediatrics, November 1, 1982; 21(11): 659 - 663.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
J. W. Greene, C. Hara, S. O'Connor, and W. A. Aftemeier
Management of Febrile Outpatient Neonates
Clinical Pediatrics, June 1, 1981; 20(6): 375 - 380.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
H. M. Feder JR
Occult Pneumococcal Bacteremia and the Febrile Infant and Young Child: A Clinical Review
Clinical Pediatrics, July 1, 1980; 19(7): 457 - 462.
[Abstract] [PDF]

Home page
 CLIN PEDIATRHome page
D. Chitayat
(Continued from page 145)
Clinical Pediatrics, February 1, 1980; 19(2): 151 - 151.
[PDF]

Home page
 CLIN PEDIATRHome page
J. S. O'shea
Assessing the Significance of Fever in Young Infants: The Diagnostic and Prognostic Value of Cerebrospinal Fluid and Other Clinical and Laboratory Findings
Clinical Pediatrics, November 1, 1978; 17(11): 854 - 856.
[PDF]

Home page
 CLIN PEDIATRHome page
H. J. Hamrick and C. T. F. Murphy
Bacteremia in 28 Ambulatory Children: Relationship to Pneumonitis and Meningitis
Clinical Pediatrics, February 1, 1978; 17(2): 109 - 112.
[Abstract] [PDF]