title: Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review.
abstract: OBJECTIVE
  To evaluate the incidence of bacteremia, and the isolated pathogens, in well-appearing children with fever without source (FWS) presenting to the pediatric emergency department (PED), after pneumococcal conjucate vaccine - 7 valent (PCV-7) widespread introduction in the Veneto region of north-eastern Italy, and to review the main literature contributions on the subject.
  
  
  METHODS
  Blood cultures performed at the PED of Padova from 1 June 2006 to 31 January 2009 in febrile children aged 1-36 months were retrospectively retrieved. Medical records of previously healthy well-appearing children with FWS were identified and reviewed.
  
  
  RESULTS
  The study finally included 392 patients. Bacteremia rate was 0.34% (95% CI 0-1) in the age group 3-36 months and 2% (95% CI 0-4.7) in infants 1-3 months. No Streptococcus pneumoniae was isolated. The literature review identified 10 relevant studies carried out in the USA and Spain showing an overall bacteremia rate <1% for feverish children aged 3-36 months, with values <0.5% in settings with high PCV-7 coverage.
  
  
  CONCLUSIONS
  Overall bacteremia rate is currently <0.5% in well-appearing children aged 3-36 months with FWS attending the PED in areas with PCV-7 widespread vaccination and is sufficiently low to preclude laboratory testing in favour of close follow-up. Further research is needed to evaluate a more conservative approach in infants 2-3 months of age.
authors.affiliation: Department of Pediatrics, University of Padova, Italy. silvia.bressan.1@unipd.it
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.forename: Paola
authors.initials: P
authors.lastname: Berlese
authors.forename: Teresa
authors.initials: T
authors.lastname: Mion
authors.forename: Susanna
authors.initials: S
authors.lastname: Masiero
authors.forename: Antonietta
authors.initials: A
authors.lastname: Cavallaro
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014611:Vaccination; D018074:Vaccines, Conjugate
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate