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Bacteremia in previously healthy children in Emergency Departments: clinical and microbiological characteristics and outcome

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Abstract

A blood culture (BC) is frequently requested in both patients with a suspected occult bacteremia/invasive infection as well as those with certain focal infections. Few data are available on the characteristics of patients in whom a bacteremia is identified in the Pediatric Emergency Department (PED). A prospective multicenter registry was established by the Spanish Pediatric Emergency Society. Epidemiological data, complementary test results, clinical management, and final outcome were recorded. Data from the first three years of the registry were analyzed. A true bacterial pathogen grew in 932 of 65,169 BCs collected [1.43 %; 95 % confidence interval (CI) 1.34–1.51 %], with 711 of them collected in patients without previously known bacteremia risk factors. Among them, 335 (47.1 %) were younger than 1 year old and 467 (65.7 %) had a normal Pediatric Assessment Triangle (PAT) on admission. Overall, the most frequently isolated bacterial species was Streptococcus pneumoniae (27.3 %; 47.6 % among patients with an altered PAT). The main pathogens were Escherichia coli (40.3 %) and S. agalactiae (35.7 %) among patients younger than 3 months, S. pneumoniae among patients 3–60 months old (40.0 %), and S. aureus (31.9 %) among patients over 60 months of age. Neisseria meningitidis was the leading cause of sepsis in patients older than 3 months. Eight patients died; none of them had a pneumococcal bacteremia and all had abnormal PAT findings on admission. S. pneumoniae is the main cause of bacteremia in patients without bacteremia risk factors who attended Spanish PEDs. Age and general appearance influence the frequency of each bacterial species. General appearance also influences the associated mortality.

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Acknowledgments

We gratefully acknowledge the contribution of the members of the Bacteraemia Study Working Group from the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies. The 22 participating centers and their researchers were:

Hospital Sant Joan de Déu Barcelona. Universitat de Barcelona (Joaquín Astete), Hospital Universitari Vall D’Hebrón (Nuria Worner, Susana Melendo), Niño Jesús Children’s University Hospital (Mercedes de la Torre, Mercedes Alonso), Cruces University Hospital (Edurne López, Jorge Barrón), Canaries University Hospital Maternity Ward (Sara García), Son Espases University Hospital (Carmen Pérez, José Gil), Hospital Universitario 12 de Octubre (Olga Ordóñez, Francisca Sanz), Príncipe de Asturias University Hospital (María Ángeles García, Peña Gómez), Corporació sanitaria Parc Tauli. Hospital de Sabadell. Institut universitari Parc Tauli - UAB (Laura Marzo, Dionisia Fontanals), Basurto University Hospital (María Landa, José Luis Díaz de Tuesta), Cabueñes Hospital (Ramón Fernández, Elisa García), Althaia. Xarxa Assistencial Universitaria de Manresa (Zulema Lobato, Montse Morta), Mendaro Hospital (Jesús Alustiza, Jose María Manterota), Hospital Moncloa (Alfonso González, Luis Moises Ruíz), Alto Deba General Hospital (Itziar Iturralde, Goizalde López, Ainara Rodríguez), Hospital Universitario Virgen de la Arrixaca (José Rodríguez, Ana Blázquez), Hospital Universitario Infanta Sofía (Alfredo Tagarro, Esteban Aznar), Hospital Universitari Sant Joan de Reus (Neus Rius, Clara Calbet), Hospital General de Catalunya (Esther Oliva), Hospital Universitario Reina Sofía (Francisca Aguilar, Angela Bello), Hospital Universitario Río Hortega (María Nathalie Campo Fernández, Garazi Fraile), Hospital del Tajo (Clara García-Bermejo), S.A.M.U.R. - Municipal Emergency and Rescue Assistance Service (Nieves de Lucas).

Special thanks also go to Dr. de Lucas for designing the data collection forms and collaborating in the statistical analysis of the data.

Conflict of interest

The authors have no conflicts of interest to disclose.

Source of funding

No external funding was secured for this study and the authors have no financial relationships relevant to this article to disclose.

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Authors and Affiliations

  1. Pediatric Emergency Department, Cruces University Hospital, University of the Basque Country, Bilbao, Spain

    B. Gomez & S. Mintegi

  2. Pediatrics and Pediatric Emergency Departments, Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Barcelona, Spain

    S. Hernandez-Bou & J. J. Garcia-Garcia

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  1. B. Gomez
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  4. S. Mintegi
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On behalf of the Bacteraemia Study Working Group from the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies (SEUP)

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Correspondence to B. Gomez.

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Gomez, B., Hernandez-Bou, S., Garcia-Garcia, J.J. et al. Bacteremia in previously healthy children in Emergency Departments: clinical and microbiological characteristics and outcome. Eur J Clin Microbiol Infect Dis 34, 453–460 (2015). https://doi.org/10.1007/s10096-014-2247-z

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