Predictors of occult

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Predictors of occult

  1. 1. Predictors of occult pneumococcalbacteremia in young febrile children in theera of pneumococcal conjugated vaccine Mintegi Raso S, Benito Fernández J, Iturralde Orive I, Dopazo LPaediatric Emergency Department. Hospital Cruces. Bilbao. Basque Country
  2. 2. Background• Classically reported, well-appearing children aged 3-36 months with FWS>39ºC, pneumococcal occult bacteremia (PnOB) rate: – >15.000 WBC/mmm3: 6% – >10.000 ANC /mmm3: 8%
  3. 3. Background• Changes in PnOB prevalence and distribution of serotypes due to PCV-7 may have altered the yield of complete blood count (CBC) in order to select patients at risk of having PnOB.
  4. 4. Objective• To analyze the yield of the CBC in order to identify children at risk for PnOB in the era of PCV-7.
  5. 5. Methods• Retrospective review – Well appearing children 3 to 36 months of age, FWS – presenting to the PED of a tertiary teaching hospital (Hospital Cruces, Basque Country) – October 1, 2004 and September 30, 2006 – CBC and a blood culture (BC) performed as part of their evaluation for fever• Patients with altered urinanalysis were excluded.• n=1586
  6. 6. Results• Positive blood culture : – 16 children 1% – Pneumococcus 11 0.7% salmonella enteritidis 1 enterococcus faecium 1 group A Streptococcus 1 meningococcus B 2 Streptococcus pneumoniae 11
  7. 7. Results – PPV of WBC and ANC WBC count Absolute Neutrophil Count 1040 1177 546 409 2 PnOB 9 PnOB 3 PnOB 8 PnOB <15000 >15000 <10000 >10000PPV 1,64 NPV 99,8 PPV 1,95 NPV 99,7
  8. 8. Results – PCV7-bacteremia rate Doses of PCV-7 933 157 208 161 60 67 None 1 2 3 4 Unknown Doses of PCV-7 PnOB rate Less than 2 0.82% 2 or more 0.23%
  9. 9. Results – PPV related with doses of PCV-7 WBC > 15000. PnOB PPV ANC > 10000. PnOB PPV 1,8 2 0,9 0,6less than 2 2 or more 0-1 dosis >2dosis PCV-7 doses PCV-7 doses
  10. 10. Limitations• Retrospective study• Not-multicenter• Inclusion only of those well-appearing children aged 3 to 36 months with FWS ≥ 39ºC, in which physician obtained a CBC and blood culture as part of their evaluation for fever
  11. 11. Conclusions• In the era of PCV-7, rate of PnOB is different in children related with the pneumococcal vaccination status.• The yield of the CBC is lower than in the pre-vaccinal era.• Decisions based on the analytical results must be reconsidered, mainly in the infants with at least 2 doses of VCN.

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