title: Prevalence of occult bacteremia in children aged 3 to 36 months presenting to the emergency department with fever in the postpneumococcal conjugate vaccine era.
abstract: OBJECTIVE
  The goal of this study was to identify the prevalence of occult bacteremia (OB) in well-appearing, previously healthy children aged 3 to 36 months who present to the emergency department (ED) with fever without source in the post-pneumococcal conjugate vaccine (PCV) era.
  
  
  METHODS
  This was a retrospective cohort study of children presenting to an urban pediatric ED between July 1, 2004, and June 30, 2007. Children were included if they were aged 3 to 36 months, febrile, and previously healthy; had no source of infection on examination; had a blood culture drawn; and were discharged from the ED. Outcome measures were rates of OB and contaminant rates.
  
  
  RESULTS
  A total of 8,408 children met all inclusion criteria. There were 21 true-positives, yielding an OB rate of 0.25% (95% confidence interval [CI] = 0.16% to 0.37%). There were 159 contaminant cultures yielding a contaminant rate of 1.89% (95% CI = 1.61% to 2.19%), or a ratio of 7.6 contaminants for each true-positive. There were 14 included patients who grew Streptococcus pneumoniae from the blood, for a rate of 0.17% (95% CI = 0.09% to 0.27%).
  
  
  CONCLUSIONS
  Given the current rate of OB in the post-PCV era, it may no longer be cost-effective to send blood cultures on well-appearing, previously healthy children aged 3 to 36 months who have fever without source.
authors.affiliation: Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, AZ, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wilkinson
authors.forename: Blake
authors.initials: B
authors.lastname: Bulloch
authors.forename: Matthew
authors.initials: M
authors.lastname: Smith
mesh_terms: D001130:Arizona / Q000453:epidemiology; D016470:Bacteremia / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D001431:Bacteriological Techniques / Q000379:methods*; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology