Bacteremia in feverish children presenting to the emergency department: a retrospective study and literature review

Acta Paediatr. 2012 Mar;101(3):271-7. doi: 10.1111/j.1651-2227.2011.02478.x. Epub 2011 Oct 15.


Aim: To evaluate the incidence of bacteremia, and the isolated pathogens, in well-appearing children with fever without source (FWS) presenting to the pediatric emergency department (PED), after pneumococcal conjucate vaccine - 7 valent (PCV-7) widespread introduction in the Veneto region of north-eastern Italy, and to review the main literature contributions on the subject.

Methods: Blood cultures performed at the PED of Padova from 1 June 2006 to 31 January 2009 in febrile children aged 1-36 months were retrospectively retrieved. Medical records of previously healthy well-appearing children with FWS were identified and reviewed.

Results: The study finally included 392 patients. Bacteremia rate was 0.34% (95% CI 0-1) in the age group 3-36 months and 2% (95% CI 0-4.7) in infants 1-3 months. No Streptococcus pneumoniae was isolated. The literature review identified 10 relevant studies carried out in the USA and Spain showing an overall bacteremia rate <1% for feverish children aged 3-36 months, with values <0.5% in settings with high PCV-7 coverage.

Conclusion: Overall bacteremia rate is currently <0.5% in well-appearing children aged 3-36 months with FWS attending the PED in areas with PCV-7 widespread vaccination and is sufficiently low to preclude laboratory testing in favour of close follow-up. Further research is needed to evaluate a more conservative approach in infants 2-3 months of age.

Publication types

  • Review

MeSH terms

  • Bacteremia / complications
  • Bacteremia / epidemiology*
  • Bacteremia / microbiology
  • Bacteremia / prevention & control
  • Child, Preschool
  • Emergency Service, Hospital
  • Female
  • Fever / microbiology*
  • Humans
  • Incidence
  • Infant
  • Italy / epidemiology
  • Male
  • Pneumococcal Infections / complications
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines
  • Retrospective Studies
  • Spain / epidemiology
  • United States / epidemiology
  • Vaccination
  • Vaccines, Conjugate


  • Pneumococcal Vaccines
  • Vaccines, Conjugate