Positive blood cultures in pediatric emergency department patients: epidemiological and clinical characteristics.

OBJECTIVE

To determine the frequency of the emergency department (ED) visits of bacteraemic children and to compare the clinical characteristics of the discharged patients with those of the admitted patients.

METHODS

We retrospectively reviewed the visits of the pediatric ED patients younger than 18 years old in a medical center located in southern Taiwan during a 17-month period between September 1, 2001 and January 31, 2003, and the blood cultures significant organisms were isolated.

RESULTS

Totally, 48,279 pediatric patients visited the ED. The blood cultures were ordered for 16% (7,923) of the patients, whose positive result was 4.2% (329), whose 0.8% (60) was, however, from where true pathogen isolated, and whose contamination rate was 3.4% (269). Seventeen patients (28%) were discharged and 43 patients (72%) were admitted who subsequently proved to be bacteraemic. The latter had significantly higher white blood cell count (13.03+/-5.75 vs. 8.75+/-3.25 x10(3)/mm(3)), higher C-reactive Protein (75.48+/-59.48 vs. 12.96+/-0.73 mg/L), more antibiotic treatment and more Pneumococcus bacteremia (28% vs. 0%) than the former which had significantly more Moraxella catarrhalis bacteremia (29.4% vs. 0%) than the latter. Non-typhi Salmonella were the most common isolated organisms, regardless of the ED children who were discharged (52.9%) or admitted (37.2%). There were no significant differences between the two groups in terms of the distribution of gender, age, major initial diagnosis and the percentage of band and segment form of WBC. Of the seventeen pediatric patients who were discharged initially, no focal suppurative complication or mortality was disclosed later.

CONCLUSION

Careful clinical examination and laboratory data assessment (WBC and CRP) in the ED prevented no discharge of some pediatric patients who were subsequently found to be bacteremic. As the pathogens of the ED patients who were discharged earlier were rarely susceptible to the selected antibiotics, we believe that close contact and regular follow up of these patients who have the blood cultures done in the ED are preferable to empiric antibiotic therapy.