Emergency Medicine: All Areas
Emergency Medicine 1
Michael A. Haynes, DO MHM (he/him/his)
Pediatric Emergency Medicine Fellow
Phoenix Children's Hospital
SCOTTSDALE, Arizona, United States
Bacteremia in unvaccinated children is a widely studied topic for infants between the ages of 0 and 3 months resulting in guidelines for the care of these infants. Risk of bacteremia in children over 3 months of age was widely studied until the development of the pneumococcal 7-valent and 13-valent conjugate vaccines. There is a resurgence of unvaccinated children within the United States especially in areas with ethical exemptions. There is little data on the occurrence of bacteremia in unvaccinated children between the ages of 3 and 36 months. Although there are guidelines for vaccinated children in this age group there are no guidelines for unvaccinated children.
Objective:
The primary aim is to evaluate the incidence of bacteremia in unvaccinated children between the ages of 3 and 36 months. Our secondary aim is to compare rates of bacteremia between unvaccinated children and vaccinated children between 3 to 36 months.
Design/Methods:
We conducted an observational retrospective study and evaluated fully vaccinated, partially vaccinated and unvaccinated children between 3 and 36 months who presented between July 2020 to February 2022 to the emergency department of a tertiary pediatric referral center and had a peripheral blood culture collected. Children were excluded if they were younger than 3 months, older than 36 months, had a central venous catheter, and/or were immunocompromised.
Results:
Currently, 385 out of 3000 patient records have been reviewed to date, with 304 subjects meeting inclusion criteria. Fully vaccinated for age included 173 subjects, 89 subjects were partially vaccinated, and 37 subjects were unvaccinated (Figure 1). A total of 12 subjects had positive blood cultures, with two of those determined to be noncontaminants. Both positive cultures grew Group B Streptococcus (GBS). One subject with GBS bacteremia was fully vaccinated and the other was unvaccinated. Preliminary data show the rate of noncontaminant bacteremia of the entire cohort was 0.67%. The rates of noncontaminant bacteremia were 0.58%, 0.0%, and 2.70% for fully vaccinated, partially vaccinated and unvaccinated children, respectively.
Conclusion(s):
The rate of noncontaminant bacteremia of unvaccinated children between the ages of 3 and 36 months was higher than partially and fully vaccinated children. These results indicate a need to establish clinical guidelines for the evaluation of this patient population presenting with fever.