Clinical Profiles and Complete Blood Count Could Not Identify Children Aged 3 to 36 Months Who Had Fever Without Source at High Risk for Bacteremia

Objectives: To evaluate the incidence and causes of occult bacteremia and whether clinical profiles and complete blood count could reliably identify high-risk-for-bacteremia children aged 3 to 36 months who had fever without source (FWS). Material and Methods: The medical data of children aged 3 to 36 months who presented with FWS for 1 to 7 days but with no clinical signs of sepsis and were subsequently hospitalized between January 2007 and December 2017 with one or more of the following high risk features, body temperature >39 degrees Celsius, inactive behavior, white blood cell (WBC) count >15,000 cells per cubic millimeter (cells/mm), absolute neutrophil count >10,000 cells/mm, or absolute band count >1,500 cells/mm, were recorded. Results: Bacteremia was found in 12 of 160 (7.5%) children with one or more of the high-risk features. The pathogens were non-typhoidal Salmonella (5 patients), Streptococcus pneumoniae (4 patients), and Salmonella Typhi (3 patients). None of the high-risk features could differentiate between children with and without bacteremia. Five of the 8 patients with Salmonella septicemia had normal WBC counts leading to delays in prescribing empirical antibiotics and none of them had complications. None of the 117 patients in the non-bacteremia group who did not receive antibiotics or discontinued them after negative hemoculture had complications during hospitalization. Conclusion: High-risk features could not help to identify occult bacteremia in children aged 3-36 months who had FWS.