Community acquired bacteremia in a paediatric hospital

Information was collected retrospectively for one year on children presenting with community acquired bacteremia to a paediatric hospital, Between Ist October 1996 and 31st September 1997, Thirty eight children were identified (21 males and 17 females). Twenty nine (76%) patients presented directly to the accident and emergency department, Ages ranged from one week to 14 years (mean 22.8 months, median 8 months). Symptoms occurred for 12 hours to 7 days (mean 2.2 days,median I day) prior to presentation and included fever (63%), vomiting (31%), lethargy (31%), poor feeding(28%), irritability (26%), and diarrhoea (8%). A probable source for the bacteremia was identified retrospectively in a total of 17 cases; urinary tract infection (7), skin infection (6), septic arthritis (2), and pneumonia (2), Organisms included N.meningitides (29%), S.pneumococcus (26%), E.coli (18%) and S.aureus (21%). No significant resistance patterns were identified. Initial empiric antibiotic therapy included cefotaxime in 23 (61%) cases, Thirty five (90%) patients experienced complete recovery, Three (8%) patients suffered serious sequelae, The introduction of national HiB vaccination appears to have impacted on the incidence of community acquired bacteremia especially in the younger age group. Patient outcome following community acquired bacteremia is generally good. Antibiotic resistance,has not yet emerged as a significant problem but current choice of empiric antibiotic therapy may need to be reviewed, Accident and emergency departments are continuing to be used as primary care centres for sick children in Dublin.