OCCULT BACTEREMIA - IS THERE A STANDARD OF CARE

The evaluation and management of patients with occult bacteremia is co ntroversial. The purpose of this study was to define the prevailing pr actices in the emergency management of occult bacteremia. Short, anony mous surveys were mailed to all 517 members of the Section on Emergenc y Medicine at the American Academy of Pediatrics. Three hundred six (5 9%) of those surveyed returned completed questionnaires. Eleven differ ent temperature cutoff points are used, and 105 (34%) consider occult bacteremia in patients with temperature above 39-degrees-C. Seventeen different age intervals are used to define the patients at risk for oc cult bacteremia, and the age range three to 24 months is used by 173 ( 57%) of those surveyed. Complete blood cell count is the most commonly used screening test; it is routinely ordered by 225 respondents (74%) . One hundred thirty-seven participants (45%) routinely obtain blood c ultures in all patients at risk for occult bacteremia, whereas 111 (36 %) use the clinical appearance (toxicity) of the patient to determine whether a blood culture should be drawn. One hundred sixty-one (53%) o f those surveyed routinely administer antibiotics to toxic-appearing p atients pending the results of the blood culture. Laboratory criteria are used by 135 (44%) in the decision whether to administer empiric an tibiotics. Ceftriaxone is the most commonly used antibiotic; it is rou tinely administered by 230 respondents (75%). Twenty participants (7%) routinely admit all patients with Streptococcus pneumoniae, whereas 2 17 (71%) admit all patients with Haemophilus influenzae bacteremia and 234 (76%) admit all patients with Neisseria meningitidis bacteremia. We conclude that diversity exists in the evaluation and management of occult bacteremia.