I hope no one minds, but I would like to visit, revisit more appropriately, occult bacteremia. Recently, Contemporary Pediatrics did a rather good supplement on Streptococcus pneumoniae. I have to admit I was disappointed because it did not address the topic of occult bacteremia.
I'd like to get a concusses, people can respond to me directly or not and I will summarize. In general I consider those most at risk to be children 3 to 36 mo (too old now?) with a temperature of > 39.
What temperature and age groups are others using?
If a child has an otitis media and a temperature of 40, would you still get a blood culture?(Original studies showed that OM did not change the risk for OB. I may get a BCx and no CBC and treat the OM.
At what age cut off are those of you NOT obtaining urine cultures on boys?( > 6 mo or it there are any symptoms or a previous UTI)
If a little girl has an obvious OM and a temperature of 40 would you get a blood culture or a urine culture?
These are just a few of my questions. I remember when I was a fellow in PEM that I really thought I would know what to do with a fever-HA! I remember Pediatrics printed a special article in 1993 (Baraff etall.Jay P. you reviewed it Journal Club!) about guidelines and to my knowledge no recent article has been published like it.I could find no AAP policy statements either. Thanks in advance and Happy New Year to all.
Michelle Rubinstein, MD
PEM-Henry Ford Hospital
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