Management of children with occult bacteremia who are treated in the emergency department.

Occult bacteremia, which precedes many serious infections in children, is most often due Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, or Salmonella species. Diagnosis on the basis of clinical judgment is unreliable, although the presence of certain risk factors may suggest the diagnosis. These risk factors include an age of 3 months to 3 years, a temperature of greater than or equal to 39.0 degrees C, and a white blood cell count of greater than or equal to 15,000/mm3. Although results are delayed, a culture of blood is the only definitive test. Studies suggest that treatment with various antibiotics may be helpful, but that some drugs, particularly orally administered amoxicillin, should not be relied on to eliminate occult bacteremia or prevent its most serious sequela, meningitis.