Bacteremia in an ambulatory setting. Improved outcome in children treated with antibiotics.
We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes. Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae. The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients. The effect of treatment was greater for patients with S pneumoniae than those with H influenzae. Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.
Woods
E R
ER
Division of Adolescent/Young Adult Medicine, Children's Hospital, Boston, MA 02115.
Merola
J L
JL
Bithoney
W G
WG
Spivak
H
H
Wise
P H
PH
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001900:Boston / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D005260:Female; D006192:Haemophilus Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D006193:Haemophilus influenzae; D006776:Hospitals, Pediatric / Q000592:standards; D006801:Humans; D007223:Infant; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D011008:Pneumococcal Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
D000900:Anti-Bacterial Agents