{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T08:15:24Z","timestamp":1788682524567,"version":"build-2803163510"},"reference-count":42,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2000,9,1]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To evaluate selected characteristics of occult bacteremia in the post-Haemophilus influenzae type b (HIB) vaccine era.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>A retrospective cohort study was performed involving 5901 children 2 to 24 months old with fever \u226539.0\u00b0C evaluated with a blood culture at an urban tertiary care children's hospital emergency department (ED) between February 1993 and June 1996. Patients were excluded if immune-suppressed, diagnosed with a focal infection, evaluated by lumbar puncture, or admitted to the hospital during initial evaluation. Prevalence of occult bacteremia, distribution of current pathogenic organisms, and time to positive culture in a continuously monitored system were determined. All patients with cultures positive for pathogenic bacteria were reevaluated and serious adverse outcomes were documented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The prevalence of occult bacteremia was 1.9% (95% confidence interval: 1.5%\u20132.3%). Streptococcus pneumoniae accounted for 82.9% of all pathogens and H influenzae was not a causative organism in this cohort.<\/jats:p><jats:p>The mean time to positive culture was significantly shorter for pathogens compared with contaminants (14.9 hours vs 31.1 hours). A culture that was positive in \u226418 hours was 13.0 (6.3\u201326.6) times more likely to contain a pathogen than a contaminant.<\/jats:p><jats:p>The average time from positive culture notification to reevaluation in the ED was 10.6 hours and over half of the patients recalled to the ED for positive cultures were admitted to the hospital. Of patients with occult pneumococcal bacteremia, 95.7% had resolution of their bacteremia without the use of parenteral antibiotics. Two patients had serious adverse outcomes. The rate of meningitis or death was .03% (.004%\u2013.12%).<\/jats:p><jats:p>The contamination rate of blood cultures was 2.1% (1.7%\u20132.5%). Most (85%) of these patients were reevaluated in the ED and more than one third were admitted to the hospital before full identification of the organism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions.<\/jats:title><jats:p>Prevalence of occult bacteremia in the post-HIB vaccine era is lower than previously reported.S\u2008pneumoniae is the most common causative organism and resolves without parenteral antibiotics in the vast majority of cases. Continuously monitoring blood culture systems allow for early identification and can aid in differentiating contaminated from true pathogenic cultures by time to positive culture. Serious adverse outcome is an uncommon result of occult bacteremia. Updated epidemiology and microbiologic technology may impact the evaluation and treatment of children at risk for occult bacteremia.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.106.3.505","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:50:41Z","timestamp":1092441041000},"page":"505-511","source":"Crossref","is-referenced-by-count":170,"title":["Occult Bacteremia From a Pediatric Emergency Department: Current Prevalence, Time to Detection, and Outcome"],"prefix":"10.1542","volume":"106","author":[{"given":"Elizabeth R.","family":"Alpern","sequence":"first","affiliation":[{"name":"From the Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evaline A.","family":"Alessandrini","sequence":"additional","affiliation":[{"name":"From the Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis M.","family":"Bell","sequence":"additional","affiliation":[{"name":"From the Divisions of Emergency Medicine and"},{"name":"Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy N.","family":"Shaw","sequence":"additional","affiliation":[{"name":"From the Divisions of Emergency Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin L.","family":"McGowan","sequence":"additional","affiliation":[{"name":"Immunologic and Infectious Diseases, Children's Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2000,9,1]]},"reference":[{"key":"2021121003255453700_B1","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJM197306212882501","article-title":"Bacteremia in febrile children seen in a \u201cwalk-in\u201d pediatric clinic.","volume":"288","author":"McGowan","year":"1973","journal-title":"N Engl J Med."},{"key":"2021121003255453700_B2","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/S0022-3476(75)80584-1","article-title":"Bacteremia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a \u201cwalk-in\u201d clinic.","volume":"87","author":"Teele","year":"1975","journal-title":"J Pediatr."},{"key":"2021121003255453700_B3","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1056\/NEJM198711053171902","article-title":"Antibiotic administration to treat possible occult bacteremia in febrile children.","volume":"317","author":"Jaffe","year":"1987","journal-title":"N Engl J Med."},{"key":"2021121003255453700_B4","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/S0022-3476(05)83126-9","article-title":"Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia.","volume":"124","author":"Fleisher","year":"1994","journal-title":"J Pediatr."},{"key":"2021121003255453700_B5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1097\/00006454-199306000-00003","article-title":"Antimicrobial treatment of occult bacteremia: a multicenter cooperative study.","volume":"12","author":"Bass","year":"1993","journal-title":"Pediatr Infect Dis J."},{"key":"2021121003255453700_B6","first-page":"901","article-title":"Progress toward elimination of Haemophilus influenzae type b disease among infants and children\u2014United States, 1987\u20131995.","volume":"45","author":"Anonymous","year":"1996","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2021121003255453700_B7","doi-asserted-by":"crossref","first-page":"624","DOI":"10.1001\/archpedi.152.7.624","article-title":"Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era.","volume":"152","author":"Lee","year":"1998","journal-title":"Arch Pediatr Adolesc Med."},{"key":"2021121003255453700_B8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0022-3476(86)80564-9","article-title":"Risk factors for development of bacterial meningitis among children with occult bacteremia.","volume":"109","author":"Shapiro","year":"1986","journal-title":"J Pediatr."},{"key":"2021121003255453700_B9","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1542\/peds.92.1.140","article-title":"Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia.","volume":"92","author":"Baraff","year":"1993","journal-title":"Pediatrics."},{"key":"2021121003255453700_B10","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1097\/00006565-199210000-00002","article-title":"Follow-up of patients with occult bacteremia in pediatric emergency departments.","volume":"8","author":"Joffe","year":"1992","journal-title":"Pediatr Emerg Care"},{"key":"2021121003255453700_B11","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1128\/jcm.31.4.793-797.1993","article-title":"Comparison of the BacT\/Alert pediatric blood culture system, Pedi-BacT, with conventional culture using the 20-milliliter Becton-Dickinson supplemented peptone broth tube.","volume":"31","author":"Krisher","year":"1993","journal-title":"J Clin Microbiol."},{"key":"2021121003255453700_B12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1097\/00006565-199402000-00006","article-title":"Evaluation of false positive blood cultures: guidelines for early detection of contaminated cultures in febrile children.","volume":"10","author":"Kornberg","year":"1994","journal-title":"Pediatr Emerg Care."},{"key":"2021121003255453700_B13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/peds.92.1.1","article-title":"Practice guideline for the management of infants and children 0 to 36 months of age with fever without source.","volume":"92","author":"Baraff","year":"1993","journal-title":"Pediatrics."},{"key":"2021121003255453700_B14","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1016\/S0196-0644(05)80991-6","article-title":"Practice guideline for the management of infants and children 0 to 36 months of age with fever without source.","volume":"22","author":"Baraff","year":"1993","journal-title":"Ann Emerg Med."},{"key":"2021121003255453700_B15","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/S0022-3476(05)81838-4","article-title":"Strategies for diagnosis and treatment of children at risk for occult bacteremia: clinical effectiveness and cost-effectiveness.","volume":"118","author":"Lieu","year":"1991","journal-title":"J Pediatr."},{"key":"2021121003255453700_B16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/S0022-3476(05)81837-2","article-title":"Management of infants at risk for occult bacteremia: a decision analysis.","volume":"118","author":"Downs","year":"1991","journal-title":"J Pediatr."},{"key":"2021121003255453700_B17","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1542\/peds.102.3.538","article-title":"Three-year multicenter surveillance of systemic pneumococcal infections in children.","volume":"102","author":"Kaplan","year":"1998","journal-title":"Pediatrics"},{"key":"2021121003255453700_B18","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1086\/520286","article-title":"Drug-resistantStreptococcus pneumoniae.","volume":"26","author":"Campbell","year":"1998","journal-title":"Clin Infect Dis"},{"key":"2021121003255453700_B19"},{"key":"2021121003255453700_B20","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1542\/peds.57.6.861","article-title":"Bacteremia in children: an outpatient clinical review.","volume":"57","author":"McCarthy","year":"1976","journal-title":"Pediatrics."},{"key":"2021121003255453700_B21","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/S0022-3476(83)80402-8","article-title":"A comparative study of the prevalence, outcome, and prediction of bacteremia in children.","volume":"103","author":"Dershewitz","year":"1983","journal-title":"J Pediatr"},{"key":"2021121003255453700_B22","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1542\/peds.87.1.48","article-title":"Bacteremia with otitis media.","volume":"87","author":"Schutzman","year":"1991","journal-title":"Pediatrics."},{"key":"2021121003255453700_B23","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0022-3476(89)80064-2","article-title":"Blood cultures in the management of febrile outpatients later found to have bacteremia.","volume":"115","author":"Alario","year":"1989","journal-title":"J Pediatr."},{"key":"2021121003255453700_B24","first-page":"657","article-title":"Status report on the childhood immunization initiative: national, state, and urban area vaccination coverage levels among children aged 19\u201335 months\u2014United States, 1996.","volume":"46","author":"Anonymous","year":"1997","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"2021121003255453700_B25","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/00006454-199709000-00006","article-title":"Impact of a false positive blood culture result on the management of febrile children.","volume":"16","author":"Santos Thuler LC, Jenicek M, Turgeon JP, Rivard M, Lebel P, Lebel MH","year":"1997","journal-title":"Pediatr Infect Dis J."},{"key":"2021121003255453700_B26","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1128\/jcm.35.3.563-565.1997","article-title":"Doing it right the first time: quality improvement and the contaminant blood culture.","volume":"35","author":"Weinbaum","year":"1997","journal-title":"J Clin Microbiol."},{"key":"2021121003255453700_B27","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1016\/S0196-0644(98)70225-2","article-title":"Predictors of occult pneumococcal bacteremia in young febrile children.","volume":"31","author":"Kuppermann","year":"1998","journal-title":"Ann Emerg Med."},{"key":"2021121003255453700_B28","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1542\/peds.87.5.670","article-title":"Temperature and total white blood cell count as indicators of bacteremia.","volume":"87","author":"Jaffe","year":"1991","journal-title":"Pediatrics."},{"key":"2021121003255453700_B29","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/00006454-198901000-00002","article-title":"Blood cultures in private pediatric practice: an eleven-year experience.","volume":"8","author":"Baron","year":"1989","journal-title":"Pediatr Infect Dis J."},{"key":"2021121003255453700_B30","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1001\/archpedi.153.3.261","article-title":"Immature neutrophils in the blood smears of young febrile children.","volume":"153","author":"Kuppermann","year":"1999","journal-title":"Arch Pediatr Adolesc Med."},{"key":"2021121003255453700_B31","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00006454-199405000-00010","article-title":"Occult pneumococcal bacteremia: what happens to the children who appear well at reevaluation?","volume":"13","author":"Korones","year":"1994","journal-title":"Pediatr Infect Dis J"},{"key":"2021121003255453700_B32","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1056\/NEJM199710023371404","article-title":"Bacterial meningitis in the United States in 1995.","volume":"337","author":"Schuchat","year":"1997","journal-title":"N Engl J Med."},{"key":"2021121003255453700_B33","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1111\/j.1553-2712.1998.tb02468.x","article-title":"Parenteral versus oral antibiotics in the prevention of serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia: a meta-analysis.","volume":"5","author":"Rothrock","year":"1998","journal-title":"Acad Emerg Med."},{"key":"2021121003255453700_B34","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1542\/peds.99.3.438","article-title":"Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia?","volume":"99","author":"Rothrock","year":"1997","journal-title":"Pediatrics"},{"key":"2021121003255453700_B35","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1542\/peds.100.1.128","article-title":"Management of the young febrile child: a commentary on recent practice guidelines.","volume":"100","author":"Kramer","year":"1997","journal-title":"Pediatrics."},{"key":"2021121003255453700_B36","first-page":"1359","article-title":"Cautionary note on the use of empiric ceftriaxone for suspected bacteremia.","volume":"145","author":"Wald","year":"1991","journal-title":"Am J Dis Child."},{"key":"2021121003255453700_B37","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S0022-3476(05)83137-3","article-title":"Antibiotic therapy in febrile children: \u201cbest-laid schemes\u2026\u201d.","volume":"124","author":"Long","year":"1994","journal-title":"J Pediatr."},{"key":"2021121003255453700_B38","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1542\/peds.84.1.18","article-title":"Should blood cultures be obtained in the evaluation of young febrile children without evident focus of bacterial infection? A decision analysis of diagnostic management strategies.","volume":"84","author":"Kramer","year":"1989","journal-title":"Pediatrics."},{"key":"2021121003255453700_B39","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/j.1553-2712.1997.tb03759.x","article-title":"The use of antibiotics to prevent serious sequelae in children at risk for occult bacteremia: a meta-analysis","volume":"4","author":"Bulloch","year":"1997","journal-title":". Acad Emerg Med."},{"key":"2021121003255453700_B40","first-page":"43","article-title":"Parents' utilities for outcomes of occult bacteremia.","volume":"154","author":"Bennett","year":"2000","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021121003255453700_B41","doi-asserted-by":"crossref","first-page":"836","DOI":"10.1016\/S0196-0644(94)70201-2","article-title":"Incorporating patient preferences into practice guidelines: management of children with fever without source.","volume":"24","author":"Oppenheim","year":"1994","journal-title":"Ann Emerg Med."},{"key":"2021121003255453700_B42","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1542\/peds.93.5.697","article-title":"Parents' versus physicians' values for clinical outcomes in young febrile children.","volume":"93","author":"Kramer","year":"1994","journal-title":"Pediatrics"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/106\/3\/505\/886549\/pe090000505p.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/106\/3\/505\/886549\/pe090000505p.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T05:06:13Z","timestamp":1705208773000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/106\/3\/505\/63075\/Occult-Bacteremia-From-a-Pediatric-Emergency"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,9,1]]},"references-count":42,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2000,9,1]]},"published-print":{"date-parts":[[2000,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.106.3.505","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"value":"1098-4275","type":"electronic"},{"value":"0031-4005","type":"print"}],"subject":[],"published":{"date-parts":[[2000,9,1]]}}}