Nothing has done more to reduce the incidence and prevalence of bacteremia in children between 3 months and 3 years of age than vaccinations—especially the Haemophilus influenza (HFlu) and pneumococcal vaccines. While the H. Flu vaccine has been available since the 1980s, the pneumococcal conjugate vaccine did not arrive until the late 1990s only to change over from the 7-valent to the 13 valent vaccine during the past decade. So what have those advances in pneumococcal vaccination meant for children over that decade and a half since the pneumococcal vaccine came into being and evolved into its present 13-conjugate form? Greenhow et al. (10.1542/peds.2016-2098) looked into this question with a retrospective review of more than 57,000 blood cultures collected in children age 3-36 months from children in the Kaiser Permanente Northern California health system. The results are triumphant in showing a 95.3% reduction in pneumococcal bacteremia during the study period in association with implementation of this important vaccine. What makes things a bit less jubilant however are the relative increase in bacteremia from E. Coli, salmonella, and staph aureus—still nowhere near the prevalence of what pneumococcal bacteremia used to be, but certainly gaining in importance when a blood culture turns positive—although with these other organisms at least 75% of the time there is an identified source causing the positive blood cultures.
Should the findings in this study change how we handle the febrile toddler without a source in the outpatient setting? The authors add their perspective in the discussion section of this paper, and perhaps our AAP Committee on Infectious Diseases will add theirs in the next edition of the Red Book—but until then, we are interested in what organisms you are seeing in your patients with bacteremia. Share your own experience by responding to this blog, posting a comment when you link to the article on our website or sharing some thoughts on our Facebook or Twitter pages.