Identification and management of the child with bacteremia

Septicemia is a term used to describe systemic illness in association with bacterial invasion of the bloodstream. Septicemic children show a variety of symptoms, determined in part by age. Neonates can manifest temperature imbalances with hyperthermia or hypothermia, tachypnea, tachycardia, apnea, lethargy, or feeding problems. The septicemic neonate of young infant is frequently irritable and difficult to console and can show signs of poor perfusion with mottling and acrocyanosis. The older infant or child with septicemia usually has a fever and can show signs of altered mental status, impaired cardiovascular function, and shock. If untreated, septicemia is a progressive and ultimately lethal condition. Bacteremia is the preferred term when viable bacteria are recovered from the blood of a patient who does not appear seriously ill. Bacteremia may be transient, sometimes occurring in the course of routine dental or surgical procedures, or it may be self-sustaining in association with various types of focal infection, such as pneumonia, meningitis, cellulitis, or infections of bones and joints. A small but clinically important percentage of febrile children without evidence of focal infection or with only seemingly trivial illnesses are bacteremic, despite appearing well enough to be managed as outpatients. This condition is referred to as occult bacteremia. Recognition of the possibility of occult bacteremia calls for an organized diagnostic and therapeutic approach aimed at eliminating infection and avoiding adverse sequelae. Because the management of the child with bacteremia and focal infection is directed toward the specific focus and not bacteremia per se, this paper gives primary consideration to the separate problem of occult bacteremia.