pediatrics
Occult Bacteremia and Fever Without Apparent Source in Infants and Young Children
Treatment
Antibiotics (empirically, for select patients pending culture results, as well as for those patients with positive cultures) Antipyretics for discomfort Adequate hydration (because of increased losses with fever and possible anorexia); oral hydration if possible, parenteral if not Children who receive antibiotics before bacteremia is confirmed by blood culture seem less likely to develop focal infections, but data are inconsistent. However, because of the low overall incidence of bacteremia, many children would receive unnecessary treatment if all who were tested were empirically treated. As above, management varies by age and other clinical factors. Regardless of age, all children are reexamined in 24 to 48 hours. Those with persistent fever or positive blood or urine cultures who have not been treated already have more cultures done and are hospitalized for evaluation of possible sepsis and parenteral antibiotic therapy. If new signs of focal infection are found on reexamination, evaluation and therapy are directed by the findings. Antipyretics in weight-based dosages are given. Antibiotics are not given unless cultures are positive. For urinary tract infection, well-appearing children may receive Treatment as outpatients; others (eg, those who appear more ill, those in whom adequate follow-up is not assured) may require admission for parenteral antibiotics. One common system for management before culture results ( see Figure: Evaluation and management of the febrile infant aged ) minimizes antibiotic use in most febrile infants who are not likely to have serious bacterial infection and provides antibiotics promptly to the few who need them. If urinalysis and urine cultures suggest urinary tract infection, well-appearing children may receive Of note, some authorities prefer to hospitalize all febrile infants<1 month of age, do a full evaluation with cultures of blood, urine, and CSF, and give parenteral antibiotics (eg,ceftriaxone) pending culture results because febrile infants < 1 month of age are the age group with the greatest incidence of SBI. 