{
 "topic": "Bacteremia",
 "slug": "bacteremia",
 "category_id": 15485,
 "passage_count": 14,
 "source_chars": 10825,
 "enough_material": true,
 "references": [
  {
   "title": "Algorithms in Pediatrics",
   "author": null,
   "pages": [
    266
   ]
  },
  {
   "title": "Berkowitz's Pediatrics",
   "author": "Berkowitz, Carol D.;",
   "pages": [
    502
   ]
  },
  {
   "title": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024",
   "author": null,
   "pages": [
    1773,
    1814,
    3260
   ]
  },
  {
   "title": "Red Book Atlas of Pediatric Infectious Diseases",
   "author": "American Academy of Pediatrics,Carol J. Baker, MD, FAAP",
   "pages": [
    557
   ]
  },
  {
   "title": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "author": null,
   "pages": []
  },
  {
   "title": "Cover",
   "author": "Vitalsource Download",
   "pages": [
    3353,
    3573,
    3849,
    5030
   ]
  },
  {
   "title": "Common Cardiac Issues in Pediatrics",
   "author": "Jonathan N. Johnson,Deepak M. Kamat",
   "pages": [
    534
   ]
  }
 ],
 "passages": [
  {
   "source": "Algorithms in Pediatrics, p. 266",
   "text": "## **CAUSES** Bacteremia will be seen in between 3 and 5% of children with fever without focus in this age group especially if the fever is more than 39\u00b0C. While bacteremia due to organisms like _Streptococcus pneumoniae, Staphylococcus_ and _Haemophilus influenzae_ is more common in children younger than 2 years, in older children, typhoid and paratyphoid fevers account for the majority of bacterial causes. Parasitic infestations like malaria also account for a large percentage of fevers in this age group in certain parts of the country in certain seasons. ## **AppROACh**"
  },
  {
   "source": "Berkowitz's Pediatrics, p. 502",
   "text": "**Box 67.2. Diagnosis of Serious Bacterial Illness in Children** w Lethargy, irritability, or change in mental status w Tachycardia disproportionate to the degree of temperature elevation w Tachypnea or labored respirations w Bulging or depressed anterior fontanel w Nuchal rigidity w Petechiae w Localized erythema, tenderness, or swelling w Abdominal or flank tenderness w Fever **ChAPTeR 67: FeveR And BACTeRemiA 477** (eg, bundling up, drinking hot tea) to increase body temperature to reach and maintain this higher set point, thus producing fever (Figure 67.1). This contrasts with hyperthermia, in which the thermoregulatory set point of the body is normal. Because of abnormal physiologic processes, heat gain exceeds heat loss, and the body temperature rises despite efforts to return to the control set point. ## **Differential Diagnosis**"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1814",
   "text": "In endemic countries, _Brucella_ spp. are an important cause of occult bacteremia in young children. Because of the organism\u2019s ability to establish chronic infection, hepatic and splenic abscesses may develop. High- grade fever and elevations in liver enzymes are common among children with primary bacteremia. Children with positive blood cultures typically have more acute presentations with increased markers of inflammation (leukocyte count, CRP, ferritin) compared with culture- negative cases. Recurrent episodes of bacteremia can also occur (<10% of cases), especially with inadequate primary treatment. These recurrent episodes are less often associated with fever (40% of cases), potentially indicating the indolent nature of chronic _Brucella_ infections in children."
  },
  {
   "source": "Red Book Atlas of Pediatric Infectious Diseases, p. 557",
   "text": "Adapted from Wharton M, Chorba TL, Vogt RL, Morse DL, Buehler JW. Case definitions for public health surveillance. _MMWR Recomm Rep._ 1990;39(RR-13):1\u201343. bacteremia and septicemia among preterm neonates, typically neonates weighing less than 1,500 g at birth, and of episodes of health care\u2013associated bacteremia in all age groups. Coagulase-negative staphylococci are responsible for bacteremia in children with intravascular catheters or those with vascular grafts or intracardiac patches, prosthetic cardiac valves, or pacemaker wires. Infection may also occur associated with other indwelling foreign bodies, including CSF shunts, peritoneal catheters, or prosthetic joints. Mediastinitis after openheart surgery, endophthalmitis after intrao c- ular trauma, and omphalitis and scalp abscesses in preterm neonates have been"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Clinical Considerations Clinical recognition: Children at highest risk for bacteremia are under 2 years of age. For meningococcus, biphasic peaks occur: one during infancy and a second during adolescence. Thus, algorithms for fever management focus heavily upon young children due to higher incidence at this age and because the signs of occult bacteremia are difficult to discern. In many tertiary care centers, the children at highest risk for bacteremia and sepsis are children with indwelling CVC, neutropenia, or short gut. These children may have baseline tachycardia from anemia, making triage recognition more problematic. Triage considerations: Recognition of abnormal vital signs (e.g., tachycardia, hypothermia) and signs of poor perfusion are critical for rapid initiation of resuscitation in the ED. Given the variation in normal vital sign ranges through the pediatric age spectrum, recognition can be facilitated if alerts are built into electronic health records."
  },
  {
   "source": "Cover, p. 5030",
   "text": "burns, atopic dermatitis, or dermatophyte infections. Associated fever, malaise, and chills may be present. In the absence of preexisting skin lesions or in the presence of fever or systemic symptoms, bacteremia should be considered, especially in very young children."
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Goals of Treatment The goals of treatment are to recognize which children may be at higher risk for bacteremia than the general pediatric population (e.g., asplenic children, children with central venous catheters [CVCs], neutropenic children) and to be cognizant of the most common organisms causing bacteremia seen in a given region. Thus, knowledge of local antibiotic resistance patterns is critical for the ED physician. Clinical Considerations"
  },
  {
   "source": "2021_Fleisher_&_Ludwig's_Textbook_of_Pediatric_Emergency_Medicine.epub",
   "text": "Graham J, Stockley K, Goldman RD. Tick-borne illnesses: a CME update. Pediatr Emerg Care 2011;27(2):141\u2013147; quiz 148\u2013150. Greenhow TL, Hung YY, Herz A. Bacteremia in children 3 to 36 months after introduction of conjugated pneumococcal vaccines. Pediatrics 2017;139(4):e20162098. Jaffe DM, Fleisher GR. Temperature and total white blood count as indicators of bacteremia. Pediatrics 1991;87(5):670\u2013674. Kuppermann N, Dayan PS, Levine DA, et al. A clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infections. JAMA Pediatr 2019;173(4):342\u2013351. Kuppermann N, Walton EA. Immature neutrophils in the blood smears of young febrile children. Arch Pediatr Adolesc Med 1999;153(3):261\u2013266. Laupland KB, Gregson DB, Vanderkooi OG, et al. The changing burden of pediatric bloodstream infections in Calgary, Canada, 2000\u20132006. Pediatr Infect Dis J 2009;28(2):114\u2013117."
  },
  {
   "source": "Cover, p. 3849",
   "text": "major organ dysfunction. Bacteremia without a focal infection may result in a self-limited illness or a severe and life-threatening illness, particularly in newborns or children with underlying disease. Bacteremia is often polymicrobial with other enteric microorganisms. Mortality occurs in up to 25% of cases but is hard to separate from the underlying health problems. In newborns, infection may present as early-onset sepsis in the first several days of life, similar to early-onset group B streptococcal sepsis. However, most neonatal enterococcal infections are nosocomial and occur after the second week of life, typically in the setting of bacteremia attributable to line infection or necrotizing enterocolitis. The most common presenting signs are apnea, bradycardia, respiratory dysfunction, fever or hypothermia, and abdominal distention. ## **DIAGNOSIS**"
  },
  {
   "source": "Cover, p. 3573",
   "text": "**TABLE 235-2 COMPARISON OF SIGNS AND SYMPTOMS IN CHILDREN WITH RESPIRATORY SYNCYTIAL VIRUS VERSUS PNEUMOCOCCAL PNEUMONIA** ![](/tmp/pdf-images/pdf-3573-00.png) ## **DIAGNOSIS** Determining the etiology of pneumonia in children is challenging because bacteremia is uncommon even in those thought to have bacterial pneumonia; pleural effusion is present in only a small percentage of children, and antimicrobial therapy has often been administered prior to collection of body fluids for culture; nasopharyngeal cultures are not necessarily representative of lower respiratory tract secretions; and the vast majority of children do not produce sputum. More aggressive procedures, such as lung puncture and BAL, may be diagnostic but are generally reserved for hospitalized patients with significant respiratory distress and, therefore, only inform us about a select population of children with pneumonia. ## **LABORATORY TESTING**"
  },
  {
   "source": "Cover, p. 3353",
   "text": "Occult bacteremia is usually defined as bacteremia occurring without the expected associated symptoms of toxicity, cardiorespiratory changes, or evidence of focal infection. Prior to the introduction and routine use of the pneumococcal conjugate vaccine in infancy, occult bacteremia due to pneumococcus was a relatively common cause of fever in young children, accounting for 90% or more of positive blood cultures in children younger than 3 years of age in the United States. About 8% of children with fever and an absolute neutrophil count (ANC) > 10,000/\u03bcL had a positive blood culture for _Streptococcus pneumoniae_ , and children with such an ANC and a fever of > 41\u00b0C had about a 20% risk of bacteremia. Of children with pneumococcal bacteremia, the majority recovered spontaneously, but about 3% to 5% developed meningitis, and another 5% developed another focal infection, most commonly pneumonia."
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 1773",
   "text": "bacteremia after nontyphoidal _Salmonella_ in U.S. settings. Bacteremia is usually accompanied by fever in older children but is often not associated with fever in infants. As described earlier, specific vulnerable hosts are far more likely to have systemic infection. Children with HIV can have recurrent nontyphoidal _Salmonella_ septicemia, despite antibiotic therapy, even without positive stool cultures or any clear nidus of infection. Some nontyphoidal strains are more likely to result in bacteremia, even without obvious gastrointestinal symptoms, including _S. dublin_ and _S. choleraesuis._ In Africa, nontyphoidal _Salmonella_ is a much more common cause of pediatric bacteremia (see next). ## Nontyphoidal _Salmonella_ Bacteremia as Emerging Disease in Africa"
  },
  {
   "source": "Common Cardiac Issues in Pediatrics, p. 534",
   "text": "- 2) Roberts GJ, Jaffray EC, Spratt DA, et al. Duration, prevalence and intensity of bacteraemia after dental extractions in children. _Heart_ . 2006;92(9):1274\u20131277 - 3) Lucas VS, Lytra V, Hassan T, Tatham H, Wilson M, Roberts GJ. Comparison of lysis filtration and an automated blood culture system (BACTEC) for detection, quantification, and identification of odontogenic bacteremia in children. _J Clin Microbiol_ . 2002;40(9):3416\u20133420 - 4) Durack DT, Beeson PB. Experimental bacterial endocarditis. II. Survival of a bacteria in endocardial vegetations. _Br J Exp Pathol_ . 1972;53(1):50\u201353 - 5) Guntheroth WG. How important are dental procedures as a cause of infective endocarditis? _Am J Cardiol_ . 1984;54(7):797\u2013801 - 6) Roberts GJ. Dentists are innocent! \u201cEveryday\u201d bacteremia is the real culprit: a review and assessment of the evidence that dental surgical procedures are a principal cause of bacterial endocarditis in children. _Pediatr Cardiol_ . 1999;20(5):317\u2013325"
  },
  {
   "source": "Kliegman R. Nelson Textbook of Pediatrics 2-Volume Set 22ed 2024, p. 3260",
   "text": "Fig. 567.1 Kidney biopsy results from 223 children with proteinuria referred for diagnostic kidney biopsy (Glomerular Disease Collaborative Network, J. Charles Jennette, MD, Hyunsook Chin, MS, and D.S. Gipson, 2007). C1Q, Nephropathy; FSGS, focal segmental glomerulosclerosis; MCNS, minimal change nephrotic syndrome; MPGN, membranoproliferative glomerulonephritis; _n_ , number of patients. _(From Gipson DS, Massengill SF, Yao L, et al. Management of childhood onset nephrotic syndrome. Pediatrics. 2009;124:747\u2013757.)_ bacteremia. This occurs as a result of many factors, particularly hypoglobulinemia, as a result of the urinary losses of immunoglobulin (Ig) G. In addition, defects in the complement cascade from urinary loss"
  }
 ]
}