ANTIMICROBIAL TREATMENT OF OCCULT BACTEREMIA - A MULTICENTER COOPERATIVE STUDY

This prospective multicenter study was conducted to define more clearl y clinical and laboratory criteria that predict a strong probability o f occult bacteremia and to evaluate the effect of empiric broad spectr um antimicrobial treatment of these children. Children 3 to 36 months old with fever greater-than-or-equal-to 40-degrees-C (104-degrees-F) o r, greater-than-or-equal-to 39.5-degrees-C (103-degrees-F) with white blood cells (WBC) greater-than-or-equal-to 15 x 10(9)/liter, and no fo cus of infection had blood cultures obtained and were randomized to tr eatment with oral amoxicillin/potassium clavulanate or intramuscular c eftriaxone. Sixty of 519 (11.6%) study patients had positive blood cul tures: Streptococcus pneumoniae, 51; Haemophilus influenzae b, 6; Neis seria meningitidis, 2; and Group B Streptococcus, 1. Subgroups of high risk were identified as fever greater-than-or-equal-to 39.5-degrees-C and WBC greater-than-or-equal-to 15 x 10(9)/liter, 55 of 331 or 16.6% positive with increasing incidence of positive culture with increasin g increments of degrees of leukocytosis to WBC greater-than-or-equal-t o 30 x 10(9)/liter where 9 of 21 or 42.9% were positive. Subgroups of significantly lower risk were identified as fever greater-than-or-equa l-to 39.5-degrees-C and WBC <15 x 10(9)/liter, 5 of 182 or 2.7% positi ve and those with WBC <10 x 10(9)/liter, 0 of 99 or 0.0% positive. Chi ldren with positive cultures who received ceftriaxone were nearly all afebrile after 24 hours whereas a significant number who received amox icillin/potassium clavulanate remained febrile. In the 459 culture-neg ative children more amoxicillin/potassium clavulanate-treated children developed diarrhea and had less improvement in clinical scores after 24 hours than ceftriaxone-treated children. Children 3 to 36 months ol d with fever greater-than-or-equal-to 39.5-degrees-C and WBC greater-t han-or-equal-to 15 x 10(9)/liter and no focus of infection are at high risk (>16%) for having occult bacteremia. Antimicrobial treatment of febrile children with these high risk criteria appears prudent whereas routine treatment of those with low risk criteria does not. Both trea tment regimens evaluated are rational and all patients did well.