Perspectives on occult bacteremia in children.

Bacteremia in young children seen in the outpatient clinic is a reasonably frequent occurrence with occasionally serious sequelae; most patients, however, do quite well. The problem is more perplexing in infants and young children with high fever and no apparent focus of infection. Laboratory tests and clinical observations help to determine which children are at low risk of occult bacteremia and need not have blood cultured; testing and assessment are much less predictive of the child who does have occult bacteremia. Currently, it is unclear whether treating all patients at risk is warranted. In any case, very close follow-up of the patient who is sent home from the outpatient department with high fever is desirable. The prevalence of serious infections caused by pneumococcus, Hib, and meningococcus warrants continued research on the development of vaccines that effectively prevent these infections.