AAP: New Bacteremia Guidelines Needed for Febrile Outpatient Toddlers
HealthDay News — Introduction of seven-valent and 13-valent pneumococcal conjugate vaccine (PCV13) correlated with a reduction in Streptococcus pneumoniae bacteremia, according to a review published online March 10 in Pediatrics.
Tara L. Greenhow, MD, from Kaiser Permanente Northern California in San Francisco, and colleagues conducted a retrospective review of the electronic medical records of all blood cultures collected for children aged 3 to 36 months at Kaiser Permanente Northern California. A total of 57,733 blood cultures were collected from September 1, 1998, to August 31, 2014, in outpatient clinics, emergency departments, and in the first 24 hours of hospitalization.
The researchers observed a 95.3% reduction of Streptococcus pneumoniae bacteremia after implementation of routine immunization with the pneumococcal conjugate vaccine, from 74.5 to 10 to 3.5 per 100,000 children per year by the post-PCV13 period. Escherichia coli, Salmonella spp, and Staphylococcus aureus caused 77% of bacteremia as pneumococcal rates decreased. In the post-PCV13 period, 76% of all bacteremia occurred with a source.
"In the United States, routine immunizations have made bacteremia in the previously healthy toddler a rare event," the authors write. "New guidelines are needed to approach the previously healthy febrile toddler in the outpatient setting."
The research was supported by a grant from the Kaiser Permanente Northern California Community Benefit Program.