Incidence of bacteremia, urinary tract infections, and unsuspected bacterial meningitis in children with febrile seizures.

Abstract

To determine the incidence of bacteremia, urinary tract infections, and unsuspected bacterial meningitis in a cohort of children diagnosed with febrile seizures. We assembled a retrospective, consecutive case series of patients who presented to an urban tertiary care pediatric emergency department for evaluation of febrile seizures during a consecutive 12- month period. A febrile seizure was defined as a convulsion associated with a temperature > or = 38.0 degrees C occurring in a child < or = 6 years. Children with initial laboratory evidence of meningoencephalitis in the emergency department (>8 white blood cells per milliliter of cerebrospinal fluid), known seizure disorders, chronic neurologic disease, or documented immunodeficiencies were excluded. There were 243 eligible patient encounters among 218 patients during the study period. The mean age was 1.9+/-0.96 years (range 0.3-5.9, median 1.7), and 156 (64.2%) were male. Of the 243 encounters, 214 (88.1%) were for simple febrile seizures and 29 (11.9%) were for complex febrile seizures. Blood cultures were performed during 206/243 encounters (84.8%), and 6/206 (2.9%, 95%CI 0.6-5.2%) were positive, all for Streptococcus pneumoniae. All six positive cultures occurred among the 154 encounters in children 3 to 36 months with a temperature > or = 39.0 degrees C and no pretreatment with antibiotics (incidence 6/154 or 3.9%, 95% CI 0.9-6.9%). Urine cultures were performed during 130/243 encounters (53.5%), and 1/130 (0.7%, 95% CI 0.0-2.2%) yielded a bacterial pathogen. Cerebrospinal fluid analysis was performed during 66/243 encounters (27.2%), and 0/66 (0.0%, 95% CI 0.0-4.5%) yielded bacterial pathogens. Patients presenting for evaluation of febrile seizures are not at increased risk for bacteremia or urinary tract infections. Bacterial meningitis in the absence of initial laboratory evidence of meningoencephalitis is very uncommon in children diagnosed with febrile seizures.