The Incidence of Occult Bacteremia and Serious Bacterial Infection in Children with Fever of Ages 3 months to 3 years

Yeşilağaç H., Yılmaz H. L., Açıkalın Akpınar A., Kibar F., Hanta D., Karagün Ö., ...More

HEALTHMED JOURNAL, vol.10, no.4, pp.206-2013, 2016 (Peer-Reviewed Journal)

  • Publication Type: Article / Article
  • Volume: 10 Issue: 4
  • Publication Date: 2016
  • Journal Indexes: Index Copernicus
  • Page Numbers: pp.206-2013
  • Çukurova University Affiliated: Yes



Background: It was to determine the incidence, complications, and etiology of occult bacteremia and serious bacterial infections in Turkish children, ages between 3-36 months in Çukurova region of Turkey with fever of unknown origin. 

Methods: The study included children aged 3-36 months that were admitted to Pediatric Emergency Clinic between November 1, 2006 and November 1, 2007 with tympanic temperature of greater than 38.0 ºC and fever of unknown origin. The complete blood count, peripheral smear, and C-reactive protein (CRP), and blood cultures were obtained in a detailed physical examination from patients. 

Results: Among the 318 patients included in the study, 10 patients (3.1%) were found to have developed a serious bacterial infection. Occult bacteremia was detected in 4 (1.3%) patients, while pneumonia, urinary tract infection, meningitis and bacterial enteritis were found in 2 (0.6%), 2 (0.6%) patients, 1 (0.3%), and 1 (0.3%) patient, respectively. 

S. aureus, S. pneumonia, and group B streptococci were isolated from the blood culture of patients that had occult bacteremia. The patients that had bacteremia were determined to have 11.65 ± 1.41 neutrophils/mm3, 75% ± 5.8 granulocytes, 8.7% ± 3.0 mature neutrophils, and CRP value was 82.1 ± 31.7 mg/l, all were significantly higher than the values of patients without bacteremia (p = 0.028, 0.032, 0.002, and 0.006, respectively).

  Moreover, patients that developed severe bacterial infection had 15.73 ± 2.69 leukocytes / mm3, 12.31 ± 2.58 neutrophils / mm3, 78.2 %± 7.7 granulocytes and 5.1% ± 4.7 mature neutrophils, were significantly higher (p 0.044, 0.000, 0.000, and 0.040) than the values of patients without severe bacterial infection. 

While toxic granulation and fever lasting for 3-7 days were significant risks for occult bacteremia (p = 0.012, 0.01, and 0.007) and severe bacterial infections (p < 0.001, 0.002, 0.00), the gender, age, and the extent of fever were not significant.

Only 4 out of the 10 patients that developed serious bacterial infection had fever of greater than 39 °C and a leukocyte count of greater than 15.000 / mm3.

Conclusion: Occult bacteremia and serious bacterial infections should be considered in children aged 3-36 months that develop fever of unknown origin. The likelihood of serious bacterial infections increases when leukocytes are greater than 15.000 / mm3,  neutrophils are greater than 10,000 / mm3, or granulocyte percentage is greater than 70%.


Key words: Fever, serious bacterial infection, children, occult bacteremia