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Blood Culture and Bacteremia Predictors in Infants Less Than Three Months of Age With Fever Without Source

Gómez, Borja MD; Mintegi, Santiago MD; Benito, Javier MD; Egireun, Andere MD; Garcia, Diego MD; Astobiza, Eider MD

The Pediatric Infectious Disease Journal: January 2010 - Volume 29 - Issue 1 - p 43-47
doi: 10.1097/INF.0b013e3181c6dd14
Original Studies

Objectives: (1) To assess the rate of bacteremia in febrile infants less than 3 months of age admitted to a pediatric emergency department at a tertiary hospital; (2) to describe the bacteria isolated; and (3) to analyze factors related to increased probability of having a positive blood culture.

Methods: A retrospective, cross-sectional, 5-year descriptive study that includes all infants less than 3 months of age who presented with fever without source (FWS) and had a blood culture performed.

Results: A blood culture was performed in 1018 (91.5%) of 1125 infants admitted, and a bacterial pathogen was grown in 23 (2.2%) of these; 8 were associated with a positive urine culture. The most frequently isolated pathogen was Escherichia coli (9), followed by Streptococcus pneumoniae (4). The risk factors detected by multivariate analysis were: (a) being classified as “not well-appearing” (12.5% vs. 1.8%; odds ratio: 8.37) and (b) leukocyturia and/or nitrituria in a urine dipstick test (5.6% vs. 1.6%; odds ratio: 3.73). C-reactive protein value was higher than white blood cell count and absolute neutrophil count in detecting bacteremia; a 70 g/L cut-off had a specificity of 93.8%, but sensitivity of only 69.6%.

Conclusions: A positive blood culture rate of 2.2% was found in infants less than 3 months of age with FWS. C-reactive protein, white blood cell count, and absolute neutrophil count were not good bacteremia predictors. We recommend obtaining a blood culture in infants less than 3 months of age with FWS, particularly those patients considered “not well-appearing” and those with leukocyturia and/or nitrituria.


From the Paediatric Emergency Department, Cruces Hospital, Barakaldo, Spain.

Accepted for publication October 20, 2009.

Address for correspondence: Borja Gómez, MD, Paediatric Emergency Department, Cruces Hospital, Plaza de Cruces s/n, Barakaldo, Spain. E-mail:

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© 2010 Lippincott Williams & Wilkins, Inc.