Original ArticleAssociation of Bacteremia with Vaccination Status in Children Aged 2 to 36 Months
Section snippets
Methods
A retrospective cohort study of all children aged 2-36 months with blood cultures obtained in a single pediatric ED from January 1, 2013, through December 31, 2017, was performed after local institutional review board approval. This study took place in a 312-bed quaternary care pediatric referral hospital in the Northeastern US. The institution includes a 45-bed ED where 90 000 patients are seen annually by pediatric emergency medicine attendings and fellows, general pediatricians, advanced
Results
During the study period, a total of 5534 blood cultures were obtained from children aged 2-36 months who presented to a single pediatric ED. After applying exclusion criteria to the 1000 encounter random sample, 857 encounters met inclusion criteria (Figure 1). In the excluded population, 2 subjects had blood cultures positive for S pneumoniae. One subject was excluded for oncologic disease and the other was excluded for chronic steroid use; both were fully vaccinated for age. By applying our
Discussion
In this retrospective cohort study of 4742 blood cultures obtained from children in the pediatric ED, we found that vaccination status was not associated with bacteremia. The overall incidence of bacteremia in this cohort was 1.5%. The rate of bacteremia in unvaccinated children was 1.3%, whereas the rate of contaminant blood cultures was 6.4%. Well-appearing children were significantly less likely to have pathogens isolated from their blood cultures than children who were deemed ill-appearing.
References (46)
- et al.
Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis
J Pediatr
(1985) - et al.
Haemophilus influenzae type b conjugate vaccine use and effectiveness
Lancet Infect Dis
(2008) Occult bacteremia in young febrile children
Pediatr Clin North Am
(1999)- et al.
The epidemiology of childhood pneumococcal disease in the United States in the era of conjugate vaccine use
Infect Dis Clin North Am
(2005) - et al.
Parental decline of pneumococcal vaccination and risk of pneumococcal related disease in children
Vaccine
(2011) - et al.
The changing epidemiology of invasive pneumococcal disease after PCV13 vaccination in a country with intermediate vaccination coverage
Vaccine
(2018) - et al.
Predictive factors of contamination in a blood culture with bacterial growth in an emergency department
An Pediatr (Barc)
(2015) The evolving approach to the young child who has fever and no obvious source
Emerg Med Clin North Am
(2007)Management of fever without source in infants and children
Ann Emerg Med
(2000)- et al.
A modern epidemic: increasing pediatric emergency department visits and admissions for headache
Pediatr Neurol
(2018)
Prevalence and decay of maternal pneumococcal and meningococcal antibodies: a meta-analysis of type-specific decay rates
Vaccine
Haemophilus influenzae type b (Hib) seroprevalence and current epidemiology in England and Wales
J Infect
Evaluation and management of febrile children: a review
JAMA Pediatr
Probability of bacterial infections in febrile infants less than three months of age: a meta-analysis
Pediatr Infect Dis J
Practice guideline for the management of infants and children 0 to 36 months of age with fever without source
Pediatrics
Bacteremia in children 3 to 36 months old after introduction of conjugated pneumococcal vaccines
Pediatrics
Changing epidemiology of outpatient bacteremia in 3- to 36-month-old children after the introduction of the heptavalent-conjugated pneumococcal vaccine
Pediatr Infect Dis J
Occult bacteremia from a pediatric emergency department: current prevalence, time to detection, and outcome
Pediatrics
NIH Office of Science Policy. p. 1–3
Carriage of Haemophilus influenzae type b in children after widespread vaccination with conjugate Haemophilus influenzae type b vaccines
Pediatr Infect Dis J
The impact of conjugate vaccine on carriage of Haemophilus influenzae type b
J Infect Dis
WHO Postion Paper on Haemophilus influenzae type b conjugate vaccines [Internet]. Weekly Epidemiological Record. 2006. p. 445–452
An analysis of pediatric blood cultures in the postpneumococcal conjugate vaccine era in a community hospital emergency department
Pediatr Emerg Care
Cited by (3)
Prevalence and Management of Invasive Bacterial Infections in Febrile Infants Ages 2 to 6 Months
2022, Annals of Emergency MedicineCitation Excerpt :Furthermore, after additional exclusion of infants with significant conditions, our estimated invasive bacterial infection rate was even lower, only 0.3% across participating centers. In the era of widespread conjugate H influenzae type B and pneumococcal vaccination, the epidemiology of bacterial pathogens responsible for invasive infections has shifted considerably,26,28,30 with most invasive pneumococcal infections caused by serotypes not covered by the current 13-valent pneumococcal vaccine.10 In recent studies of young febrile children, gram-negative rods (E coli and Salmonella sp.), as well as Gram-positive cocci (S aureus), were the most commonly reported pathogens.28,31,32
Risk Factors for Pediatric Sepsis in the Emergency Department: A Machine Learning Pilot Study
2023, Pediatric Emergency CareImmunization Status and the Management of Febrile Children in the Pediatric Emergency Department
2023, Pediatric Emergency Care
R.T. receives a Johnson & Johnson, United States Educational Grant. The other authors declare no conflicts of interest.
Portions of this study were accepted for presentation at the Pediatric Academic Societies annual meeting in 2020 (canceled); and presented virtually at the American Academy of Pediatrics Meeting, October 2-5, 2020.