Prevalence and Characteristics of Bacteremia in Children With Prolonged Fever and Well Appearance Attending the Pediatric Emergency Department

OBJECTIVE: To analyze the prevalence and characteristics of bacteremia in well-appearing children with prolonged fever attending a pediatric emergency department. Secondary objectives were to assess the prevalence and characteristics of other confirmed bacterial infections and to evaluate the diagnostic performance of additional investigations in this population. METHODS: Retrospective observational study of well-appearing children ≤18 years presenting between October 2021 and September 2023 with fever ≥38°C lasting ≥5 days. Exclusion criteria: immunodeficiency, chronic conditions increasing infection risk, age <3 months and antibiotic therapy at presentation. RESULTS: Among 88,937 emergency department visits, 11,869 (15.8%) patients with fever were screened, 929 (7.8%) had fever ≥5 days and 742 (79.9%) met the inclusion criteria. Blood cultures were obtained in 44.1% of patients, with 2 confirmed bacteremia (0.26%), 1 due to Streptococcus pneumoniae in a child with complicated pneumonia and 1 due to Salmonella poona in an infant with acute gastroenteritis. Other confirmed or probable bacterial infections were diagnosed in 116 (15.6%): pneumonia (88, 11.9%), urinary tract infection (19, 2.5%), pharyngotonsillitis (7, 0.9%) and acute gastroenteritis (3, 0.4%). Blood tests were done in a subset: complete blood count (45.4%), C-reactive protein (46.6%) and procalcitonin (2.3%). Antibiotics were prescribed to 249 (33.6%) patients, including 24.0% without confirmed bacterial infection. CONCLUSIONS: The prevalence of bacteremia in well‑appearing children with prolonged fever was extremely low, indicating the limited utility of routine blood tests in this population. Most bacterial diagnoses were based on imaging, especially for pneumonia. Clinical assessment should remain central in decision‑making, reserving investigations for selected cases where they may meaningfully influence management.