Low risk of bacteremia in febrile children with recognizable viral syndromes

Background. Previous studies of occult bacteremia in febrile children have excluded patients with recognizable viral syndromes (RVS), There is little information in the literature regarding the rate of bacteremia in febrile c hildren with RVS, Objective. To determine the rate of bacteremia in children 3 to 36 months o f age with fever and RVS. Methods. We performed a retrospective analysis of all patients 3 to 36 mont hs of age with a temperature greater than or equal to 39 degrees C seen dur ing a 5 1/2-year period in the Emergency Department of a tertiary care pedi atric hospital. From this group those with a discharge diagnosis of croup, varicella, bronchiolitis or stomatitis and no apparent concomitant bacteria l infection were considered to have an RVS. The rate of bacteremia was dete rmined for those subjects with RVS who had blood cultures, Results. Of 21 216 patients 3 to 36 months of age with a temperature greate r than or equal to 39 degrees C, 1347 (6%) were diagnosed with an RVS, Bloo d cultures mere obtained in 876 (65%) of RVS patients, Of patients who had blood cultures, true pathogens were found in only 2 of 876 (0.2%) subjects with RVS [95% confidence interval (CI) 0.01, 0.8%]. The rate of bacteremia was 1 of 411 (0.2%) for subjects with bronchiolitis, 0 of 249 (0%) for subj ects with croup, 0 of 123 (0%) for subjects with stomatitis and 1 of 93 (1. 1%) for subjects with varicella, Conclusions. Highly febrile children 3 to 36 months of age with uncomplicat ed croup, bronchiolitis, varicella or stomatitis have a very low rate of ba cteremia and need not have blood drawn for culture.