Occult bacteremia from a pediatric emergency department.

Abstract

To the Editor. Regarding the report of Alpern et al,1 given the low rate of adverse outcome to Streptococcus pneumoniae occult bacteremia and the risks associated with false-positives and hospitalizations for positive blood cultures, one should conclude that there is no utility to blood cultures in this setting and that close follow-up without blood cultures is more valuable. 1. ↵1. Alpern ER, 2. Alessandrini EA, 3. Bell LM, 4. Shaw KN, 5. McGowan KL (2000) Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome. Pediatrics. 106:505–511. [OpenUrl][1][Abstract/FREE Full Text][2] # {#article-title-3} In Reply. We would like to thank Dr DiTraglia for his thoughtful comment concerning our recently published article.1 As pointed out in his letter, the main findings of our study highlight the low prevalence of occult bacteremia and subsequent very low risk of serious adverse outcomes. We agree that the high risk of contaminated blood cultures and subsequent medical care to evaluate patients at risk for occult bacteremia is concerning. Close follow-up is incontestably agreed upon in the care of patients at risk for occult bacteremia. In the emergency department (ED) setting, however, this follow-up is often difficult. Therefore, many practitioners may elect not to eliminate obtaining blood cultures. As we concluded in our study, a continuously monitored blood culture system may allow for early differentiation between contaminated and pathogenic cultures. The early recognition (94% within 18 hours) of true pathogenic cultures with the continuously monitored system may also allow for early and important follow-up of children with “known” occult bacteremia. This “red flag” may help focus urgent and immediate follow-up in the ED setting. Each practitioner should base medical practice on a clear understanding of the blood culture system available to his or her practice. As Dr DiTraglia points out, there is no substitute for close follow-up of patients at risk for occult bacteremia. 1. 1-1.↵1. Alpern ER, 2. Alessandrini EA, 3. Bell LM, 4. Shaw KN, 5. McGowan KL (2000) Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome. Pediatrics. 106:505–511. [OpenUrl][1][Abstract/FREE Full Text][2] # {#article-title-5} To the Editor. I read with interest the article by Dr Alpern and colleagues on occult bacteremia in the pediatric emergency department (PED).1 Their … [1]: {openurl}?query=rft.jtitle%253DPediatrics%26rft.stitle%253DPediatrics%26rft.issn%253D0031-4005%26rft.aulast%253DAlpern%26rft.auinit1%253DE.%2BR.%26rft.volume%253D106%26rft.issue%253D3%26rft.spage%253D505%26rft.epage%253D511%26rft.atitle%253DOccult%2BBacteremia%2BFrom%2Ba%2BPediatric%2BEmergency%2BDepartment%253A%2BCurrent%2BPrevalence%252C%2BTime%2Bto%2BDetection%252C%2Band%2BOutcome%26rft_id%253Dinfo%253Adoi%252F10.1542%252Fpeds.106.3.505%26rft_id%253Dinfo%253Apmid%252F10969095%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=ABST&journalCode=pediatrics&resid=106/3/505&atom=%2Fpediatrics%2F108%2F2%2F520.atom