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Bacteremia in Febrile Infants in the U.S.

December 10, 2013

Bacteremia in Febrile Infants in the U.S.

  1. Deborah Lehman, MD

E. coli was the most commonly identified cause of bacteremia in infants younger than 90 days.

  1. Deborah Lehman, MD

Approximately 2% of febrile infants have bacteremia and the most common causes in the U.S. are Group B Streptococcus (GBS), Escherichia coli, and Listeria monocytogenes. However, recent studies limited to a single geographic area have demonstrated declining rates of infections with GBS and the majority of infections in this age group attributable to E. coli. To examine more diverse trends, investigators retrospectively evaluated positive blood cultures from previously healthy febrile infants admitted to general pediatric units in six different geographic regions in the U.S. between 2006 and 2012.

Of 181 positive cultures, 19 different species were isolated from 177 patients. E. coli was the most commonly isolated pathogen (42%), followed by GBS (23%), S. pneumoniae (6%), and S. aureus (5%). More than 90% of infants with E. coli bacteremia had concurrent E. coli urinary tract infection, and 27% of infants with GBS bacteremia had meningitis. Infants with S. pneumoniae bacteremia were older than the entire group (median age, 66 vs. 34 days). No positive blood cultures for L. monocytogenes were identified, prompting the authors to question empiric antibiotic coverage for this organism.

Comment

This study confirms the importance of E. coli as a neonatal pathogen causing bacteremia in febrile infants, particularly when associated with urinary tract infection. The authors question the continued need for empiric L. monocytogenes coverage with ampicillin, however, this study excluded infants admitted to neonatal intensive care units, likely excluding early-onset cases. More data are needed before any change in empiric antibiotic coverage for infants is indicated.

  • Disclosures for Deborah Lehman, MD at time of publication Nothing to disclose

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