Prevalence And Outcome Of Occult Bacteremia In Young Febrile Children
Dr. Rachel Anuradha Sundararaj, DCH*, Dr. Prabhakar D. Moses, MD, FRCP(E)**
Professor and Head of Child Health III, Christian Medical College & Hospital, Vellore DCH *, Professor and Head of Child Health III, Christian Medical College & Hospital, Vellore DCH **
Introduction: Occult bacteremia is the condition in which bacteremia is identified without clinical evidence of sepsis and no clear foci of infection.

Aims:
1) To study the prevalence of occult bacteremia among children 3-36 months of age with fever without focus, presenting in the Paediatric Emergency Services of CMC Hospital, Vellore.
2) To study the pattern of causative organisms.

Methods:

Prospective study

Period: December 1, 2004 - August 31, 2005

Population: Infants 3-36 months of age

Inclusion criteria:
  • Fever>/= 39oC at presentation
    Duration of illness <7 days
    Not received antibiotics in the 4 days prior to this visit

Age, sex, Hib vaccine status, temperature at presentation, symptoms, examination findings and investigations recorded and analysed.

Results:
  • 77 children were studied
    Mean age - 19.2 months ; 62.3% males
    52 had Hib vaccination
  • Mean presenting temperature - 39.3°C

Diagnosis:

Diagnosis Number Percentage
Viral fever
Pneumonia
Acute gastroenteritis
Acute tonsillopharyngitis
UTI
Dengue fever
Occult bacteremia Enteric fever
Sepsis
Aseptic meningitis
Heat related illness
51
11
4
2
2
2
1
1
1
1
1
66.2
14.3
5.2
2.6
2.6
2.6
1.3
1.3
1.3
1.3
1.3

Total
77

100



72 children received empirical antibiotics.

Conclusion: One child's blood culture grew Haemophilus influenza type b. Prevalence of occult bacteremia was 1.3%. Administration of empirical antibiotics may be justified since 20.8% of the diagnoses were of bacterial origin.
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