Occult Bacteremia

Occult bacteremia is considered a possibility in any child who does not have a source for a significant fever (usually considered >39.0 C, increased rates of bacteremia as temperature rises) on physical examination laboratory tests, or radiographs. Occult bacteremia occurs in approximately 3% of such patients. The evaluation and treatment of possible occult bacteremia in young children who appear clinically well and who have good medical follow-up remain controversial. Algorithms using ED WBC testing, blood cultures, and antibiotic prophylactic treatment are frequently followed, although their sensitivity and specificity are limited in predicting occult bacteremia. The clinical significance of occult bacteremia itself remains unclear, as most patients will clear the bacteremia without treatment. Some experts worry that, if left untreated, bacteremia may cause a serious bacterial infection, such as septic arthritis or meningitis, although this is rare.

The causes of occult bacteremia in young children are multiple, with Streptococcus pneumoniae now the most common owing to the Haemophilus influenzae vaccine.

Causes

• S pneumoniae is the most common cause of OB.
• Another major cause of OB is H influenzae type B.

Symptoms

• Fever
• Nonspecific symptoms

Signs

• Fever
• Nonfocal examination

Treatment