Shah Samir S, Alpern Elizabeth R, Zwerling Lisa, Reid Jennifer R, McGowan Karin L, Bell Louis M
Division of General Pediatrics, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
Arch Pediatr Adolesc Med. 2002 May;156(5):469-72. doi: 10.1001/archpedi.156.5.469.
To evaluate the risk of bacteremia in children with febrile seizures treated as outpatients.
A retrospective cohort study was performed involving 379 children aged 2 to 24 months presenting to an urban tertiary care children's hospital emergency department with a febrile seizure between February 1, 1993, and May 31, 1996.
The mean patient age was 15.9 months, and 217 (57%) were male. In 40 patients (10.6%), the use of oral antibiotics before initial emergency department evaluation was reported. Bacteremia occurred in 8 (2.1%) of 379 children studied. None of the children with bacteremia had received previous antibiotics. The causative organisms were Streptococcus pneumoniae in 7 cases and group A Streptococcus in 1 case. There were 5 contaminated cultures (1.3%). Although 2 of the 8 children with bacteremia ultimately required admission, there were no serious adverse outcomes. Six of 7 episodes of S pneumoniae bacteremia were caused by serotypes included in the pneumococcal conjugate vaccine, which was not available at the time of this study.
Children 2 to 24 months of age with febrile seizures are at similar risk for occult bacteremia as those with fever alone. Widespread use of the pneumococcal conjugate vaccine may further decrease the incidence of bacteremia in this population.
评估门诊治疗的热性惊厥患儿发生菌血症的风险。
进行一项回顾性队列研究，纳入1993年2月1日至1996年5月31日期间到一家城市三级儿童专科医院急诊科就诊的379例2至24个月大的热性惊厥患儿。
患儿平均年龄为15.9个月，男性217例（57%）。40例（10.6%）患儿在首次急诊科评估前使用了口服抗生素。在379例研究患儿中，8例（2.1%）发生菌血症。所有菌血症患儿此前均未接受过抗生素治疗。致病菌为肺炎链球菌7例，A组链球菌1例。有5份培养物污染（1.3%）。虽然8例菌血症患儿中有2例最终需要住院，但无严重不良后果。7例肺炎链球菌菌血症中有6例由肺炎球菌结合疫苗包含的血清型引起，本研究开展时该疫苗尚未上市。
2至24个月大的热性惊厥患儿发生隐匿性菌血症的风险与单纯发热患儿相似。广泛使用肺炎球菌结合疫苗可能会进一步降低该人群菌血症的发生率。
