Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

Abstract

The diagnosis of bacteremia in children is important and it can be clinically challenging to recognize the signs and symptoms. The reported rates of bacteremia are higher in young children but with the increasing vaccine coverage, there has been a decrease in bacteremia due to the three vaccine preventable bacteria (Streptococcus pneumoniae, Haemophilus influenzae group b and Neisseria meningitidis). Notably, there have been increases in healthcare-associated bacteremias with a rise in Staphylococcus aureus and Gram negative bacteremias. This review provides a brief overview of the clinical diagnosis of bacteremia in children, focusing on the epidemiology, clinical characteristics, risk factors, antibiotic treatment, outcomes and preventative measures to reduce the incidence of bacteremia and improve morbidity and mortality.

Keywords:

• bacteremia
• children
• clinical diagnosis
• paediatric infection
• sepsis

Financial & competing interests disclosure

S Aliyu has received travel sponsorship for conferences from MSD Pharmaceuticals and Gilead Pharmaceuticals. The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Key issues

• Three of the most important influences on the incidence of bacteremia are patient age, vaccination coverage and exposure to invasive procedures. There has been a shift in the epidemiology of bacteremias, with an increasing incidence in health-care associated bloodstream infections caused by Staphylococcus aureus and enterobacteriaceae.

• Bacteremia in a child maybe self-limiting, but it is important to ascertain the etiology and underlying cause of infection. In assessing a child for bacteremia, it is important to recognize the early stages of either septic shock or individuals who have a high likelihood of developing septic shock. It is a complex syndrome displaying a tremendous degree of heterogeneity. This is one of the reasons for the challenges in developing an effective diagnostic tool.

• The most common symptom of bacteremia is noted to be a raised temperature. In children younger than 3 months, a temperature ≥38°C is indicative of a serious illness, unlike in children older than 3 months where a temperature ≥39°C is considered significant. Published studies have shown that laboratory markers (e.g., C-reactive protein, procalcitonin) may be unreliable predictors of serious bacterial infections when performed <12 h of fever duration.

• Blood cultures remain the ‘gold standard’ for the detection of bacteremia. However, blood cultures are not 100% sensitive. Various studies have looked into utilizing molecular techniques in identifying bacteria directly from blood.

• The common clinical syndromes linked with bacteremia in children are pneumonia, sepsis, meningitis, urinary tract infections and acute bone/joint infections.

• It is recommended, based on good evidence, that antibiotic treatment should be promptly administered within an hour when there is suspected or proven sepsis or serious bacterial infection and usually after appropriate blood cultures have been taken.

• A major concern is the growing antibiotic resistance rates among enterobacteriaceae and Streptococcus pneumoniae. The main driving factors in the pediatric population has been noted to be changes in childcare practices (increasing use of daycare/pre-schools) and inappropriate prescribing of antibiotics in primary care for upper respiratory tract conditions such as sore throat, otitis media, sinusitis, common cold and bronchitis, which are predominantly viral in nature. Infections due to resistant Gram-negative bacteria are a growing concern in developing and developed countries alike.

• WHO data published in 2015 noted that in 2013, 51.8% (3.3 million) children under the age of 5 years who died did so due to an infectious cause. Pneumonia, diarrhea and malaria were the leading infectious causes with pneumonia causing 14.9% of the total deaths. S. pneumoniae is noted to be the leading cause of bacterial pneumonia, meningitis and sepsis in children worldwide.

• Preventative methods have been shown to be successful. These include vaccination and the Michigan-keystone project to reduce central-line related bloodstream infections

• Implementation of guidelines to improve the recognition and management of sepsis are also associated with reduced mortality.

Notes