Bacteremia in Febrile Children: Its Correlation with Birth Weight, Feeding Practices, Vaccination and Malnutrition

Abstract

Background: In children under 3 years old, fever is a common presenting symptom to the physician. Fever may be an indication of a mild infectious process such as a viral upper respiratory infection or a more serious infectious process such as bacteremia, bone and joint infections, urinary tract infection, pneumonia, soft tissue infection, bacterial enteritis, meningitis, sepsis and possibly death. The evaluation of fever in this age group has great clinical importance, as any of the serious bacterial infections whose presence it may signal may have grave morbidity if not treated. However, there exists scanty data on risk of bacteraemia among febrile children of developing countries and what clinical predictors, if any, could identify those febrile infants with bacteraemia. Present study aims to determine the prevalence of bacteremia in febrile children and the effect of low birth weight, poor feeding practices & coverage of vaccination and malnutrition which are more prevalent in developing countries like india. Objective: 1. To assess prevalence of bacteremia among hospitalized febrile children aged 3 months to 36 month. 2. To study effect of birth weight, feeding practices, vaccination and malnutrition on bacteremia in febrile children. 3. To find out different bacterial isolates. Methods: 84 consecutive febrile children attending children emergency ward of Kamla Nehru Hospital, Bhopal, aged 3 months to 36 months with rectal temperature 38 C( 100.4F) with negative H/o of antimicrobial use and who requiring hospitalization were included in the study. Exclusion criteria were current use of antimicrobial use. Children meeting eligibility criteria were studied to identify clinical predictors of bacteremia. Study subjects underwent full clinical evaluation and had blood culture done for aerobic organisms by standard method. Variable examined were age, sex, temperature, birth weight, vaccination, feeding practices, physical indices & blood culture results. Results: 50%(42) subjects were bacteremic. Klebsiella (38%), Staph aureous (28.5%) and E. coli (23.80%) of positive cultures were commonly associated.9 variables were found to be significant independent predictor of bacteremia. These were duration of fever >3 days (p=.015), birth weight <2.5 kg, no vaccination (p=.000458), low weight for age (p=.022), stunting (p=.014), presence of edema (p=.04). Conclusion: above mentioned factors are associated with increased risk of bacteremia in febrile children. Prevention of these factors can greatly reduce the chances of bacteremia in febrile children. Clinician practicing in such a setting needs to be aware of the increased risk of bacteremia in children with these clinical features.