Bacteremia with otitis media.
To investigate the occurrence and outcome of bacteremia associated with otitis media, charts were reviewed from patients who were 3 to 36 months of age, had temperatures greater than or equal to 39 degrees C, and were diagnosed with isolated clinical otitis media. A total of 2982 patients were identified. Blood cultures were obtained from 1666 (56%). Of the 1666 patients, who had blood drawn for cultures, 50 (3.0%) had bacteremia. These included 39 with Streptococcus pneumoniae, 4 with Haemophilus influenzae, 2 with Neisseria meningitidis, 3 with Salmonella species, and 2 with Staphylococcus aureus. The incidence of bacteremia increased at higher temperatures, being 1.9% at temperatures less than or equal to 40 degrees C and 5.0% at temperatures greater than 40 degrees C. Younger children were more likely to have bacteremia; 3.7% less than or equal to 12 months of age, 2.4% 13 to 24 months of age, and 1.9% 25 to 36 months of age had blood culture results that were positive (not significant). Reevaluation of the 50 bacteremic patients showed that 9 patients had continued fever, 3 patients had persistent bacteremia, pneumonia developed in 1 patient, and meningitis developed in 1 patient. It was concluded that (1) 3% of young febrile children with otitis media have bacteremia at the time of evaluation, a rate comparable to that previously reported in children with no focus of infection; (2) the incidence of bacteremia increases at higher temperatures; and (3) most febrile children with otitis media do well. The clinician must therefore weigh the potential benefit of drawing a blood culture to identify children at risk for complications against the inherent cost, inconvenience, and discomfort.
Schutzman
S A
SA
Department of Medicine, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Petrycki
S
S
Fleisher
G R
GR
D002675:Child, Preschool; D005334:Fever / Q000503:physiopathology; D005500:Follow-Up Studies; D006192:Haemophilus Infections / Q000150:complications; D006801:Humans; D015994:Incidence; D007223:Infant; D008585:Meningitis, Meningococcal / Q000150:complications; D010033:Otitis Media / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D012480:Salmonella Infections / Q000150:complications; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D013203:Staphylococcal Infections / Q000150:complications; D013290:Streptococcal Infections / Q000150:complications