Ogawa Eiki, Shoji Kensuke, Kamidani Satoshi, Miyairi Isao
Division of Infectious Diseases, Department of Medical Specialties, National Center for Child Health and Development, Tokyo, Japan.
Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.
Pediatr Int. 2019 Jun;61(6):578-582. doi: 10.1111/ped.13862. Epub 2019 Jun 17.
Febrile children 3-36 months old, who had a body temperature >39°C and white blood cell (WBC) count >15 000/mm were known to be at risk for occult pneumococcal bacteremia (OPB) in the pre-pneumococcal conjugate vaccine (PCV) era. The positive predictive value of these criteria, however, decreased dramatically after the introduction of PCV, indicating a need for alternative criteria. A high rate of febrile seizures has been noted in children with OPB, suggesting that screening may still be practical in this population. We performed a retrospective analysis to evaluate factors that predict OPB in patients visiting the emergency department (ED) with febrile seizures.
Children 3-36 months old who visited the ED for febrile seizures and had blood cultures taken were included. Patients with underlying diseases were excluded from analysis. We performed statistical analyses comparing patient demographics according to the presence or absence of OPB.
One thousand and eighty-two patients visited the ED with febrile seizure, and blood cultures were taken in 397, of whom 87% had received more than three doses of PCV. Of the nine patients with OPB, eight (89%) met the risk criteria. In contrast, only 12% (48/388) of those without OPB met the criteria. In this population, those who fulfilled the risk criteria were more likely to have OPB than those who did not (14.3% vs 0.3%; likelihood ratio, 7.17).
High WBC count and fever may effectively predict OPB in pediatric patients with febrile seizure in the post-PCV era.
在肺炎球菌结合疫苗（PCV）时代之前，3至36个月大、体温>39°C且白细胞（WBC）计数>15000/mm³的发热儿童被认为有患隐匿性肺炎球菌菌血症（OPB）的风险。然而，引入PCV后，这些标准的阳性预测值大幅下降，这表明需要替代标准。OPB患儿中热性惊厥的发生率较高，这表明在该人群中进行筛查可能仍然可行。我们进行了一项回顾性分析，以评估在因热性惊厥就诊于急诊科（ED）的患者中预测OPB的因素。
纳入3至36个月大因热性惊厥就诊于ED并进行血培养的儿童。患有基础疾病的患者被排除在分析之外。我们根据是否存在OPB对患者人口统计学特征进行了统计分析比较。
1082例患者因热性惊厥就诊于ED，其中397例进行了血培养，其中87%的患者已接种超过三剂PCV。在9例OPB患者中，8例（89%）符合风险标准。相比之下，无OPB的患者中只有12%（48/388）符合标准。在该人群中，符合风险标准的患者比不符合标准的患者更有可能患OPB（14.3%对0.3%；似然比，7.17）。
在PCV时代之后，高白细胞计数和发热可能有效地预测热性惊厥儿科患者的OPB。
