Bacteraemia in febrile children presenting to a paediatric emergency department

Objective: To determine the prevalence of bacteraemia in young febrile chil dren presenting to a paediatric emergency department. Design: Prospective observational case study. Setting: Emergency Department of the Royal Children's Hospital, Melbourne, between May 1996 and May 1997. Participants: Patients aged 3-36 months presenting to the Emergency Departm ent with temperature greater than or equal to 39 degrees C and without spec ific viral illnesses (varicella, croup or herpes gingivostomatitis). Outcome measures: Bacteraemia (defined as presence of pathogenic bacteria i n a blood culture), white blood cell count (WCC), McCarthy score, and final diagnosis based on clinical features and investigations. Results: Bacteraemia was identified in 18 of 534 patients (3.4%). Pathogens isolated were Streptococcus pneumoniae(15), Neisseria meningitidis (2) and Klebsiella pneumoniae(1). Increased WCC counts (P<0.001) and brief duratio n of fever (P<0.001) were associated with bacteraemia. Nevertheless, clinic al features, including McCarthy scores, and high WCC counts (greater than o r equal to 20 x 10(9)/L) had < 10% predictive accuracy for bacteraemia. Ove rall, final diagnoses in the 534 febrile children included non-specific vir al infections (25%), upper respiratory tract infections (24%), otitis media (10%), gastroenteritis (9%), pneumonia (7%), and urinary tract infection ( 5%). Conclusions: Most urban Australian children aged 3-36 months presenting to a paediatric emergency department with temperature less than or equal to 39 degrees C without a clinical focus have a viral infection. However, 3%-4% have occult bacteraemia. Neither clinical features nor high WCC counts reli ably identify these patients. As empiric antibiotics may contribute to incr easing antibiotic resistance and have not been shown to prevent the rare co mplication of meningitis, we believe that close contact and regular review of these patients is preferable to empiric antibiotic therapy.