Abstract
We prospectively evaluated 545 febrile children (age 3-24mo, T ≥102° F) at risk for occult bacteremia using blood culture, CBC and differential, and CRP. Patients with malignancy, sickle hemoglobinopathy, epiglottitis, septic shock or meningitis were excluded. Bacteremia was detected in 20 (S. pneumoniae 13, H. influenzae 5, S. aureus 1, N. meningitidis 1). The sensitivity (sens), specificity (sp) and positive predictive values (PPV) of tests for identifying bactereiaic children are shown in the table. An absolute PMN of >15,000/mm3 had the highest PPV (23%). It was found in only 5.5% (30) of all patients but identified 43% of bacteremic patients. Furthermore, when a larger age range (1-39 mo, n=573) was considered, the PPV of abs PMN>15,000 was 29%. Thus, highly febrile young children with an absolute PMN > 15,000 are at extremely high risk to have bacteremia; therefore, presumptive antibiotic therapy is warranted in this subgroup of highly febrile young children pending results of blood culture.
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