In a cross-sectional study being early released in Pediatrics this week entitled, “Bacteremia in Children with Fever and Leg Pain,” Rudloff et al. attempt to validate the recent uptick in children (ages 1–18 years) with fever and acute lower extremity pain who are not from a Lyme disease–endemic area of the US and have positive blood cultures after presenting to the emergency department (ED) (10.1542/peds.2023-064095).
The authors performed chart reviews from 2018 to 2022. Among the exclusion criteria were children who had acute traumatic injury and those who had taken antibiotics within the previous 24 hours.
The authors found that 30% of patients who had blood cultures drawn had a verifiable, presumably non-contaminated blood culture. Presumed contaminants only grew from 3% of the blood culture samples obtained. All children with culture-confirmed bacteremia were admitted, and approximately half had their antibiotic regimen changed at some point during their illness.
While there may be concerns about generalizability from this single-institution Midwestern patient population, the results outlined in this research brief should serve to reaffirm the importance of obtaining a blood culture from among similarly presenting patients. And while there were other potential shortcomings candidly discussed (eg, potential selection bias given that patients with bacteremia were more likely to have been transferred to the ED from an outside hospital), it doesn’t minimize the surprisingly high numbers of positive cultures found in this study nor the need to be vigilant and, perhaps, less sheepish about obtaining a blood culture from similarly presenting patients.
