Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review

Aim: To evaluate the incidence of bacteremia, and the isolated pathogens, in well-appearing children with fever without source (FWS) presenting to the pediatric emergency department (PED), after pneumococcal conjucate vaccine - 7 valent (PCV-7) widespread introduction in the Veneto region of north-eastern Italy, and to review the main literature contributions on the subject. Methods: Blood cultures performed at the PED of Padova from 1 June 2006 to 31 January 2009 in febrile children aged 1-36 months were retrospectively retrieved. Medical records of previously healthy well-appearing children with FWS were identified and reviewed. Results: The study finally included 392 patients. Bacteremia rate was 0.34% (95% CI 0-1) in the age group 3-36 months and 2% (95% CI 0-4.7) in infants 1-3 months. No Streptococcus pneumoniae was isolated. The literature review identified 10 relevant studies carried out in the USA and Spain showing an overall bacteremia rate < 1% for feverish children aged 3-36 months, with values < 0.5% in settings with high PCV-7 coverage. Conclusion: Overall bacteremia rate is currently < 0.5% in well-appearing children aged 3-36 months with FWS attending the PED in areas with PCV-7 widespread vaccination and is sufficiently low to preclude laboratory testing in favour of close follow-up. Further research is needed to evaluate a more conservative approach in infants2-3 months of age.