eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Pneumococcal Bacteremia: Follow-up

Author: Martha L Miller, MD, Associate Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

Further Inpatient Care

  • All patients with pneumococcal bacteremia require prompt evaluation. Further testing and therapy is determined by the following:
    • Age of patient
    • Condition of patient
    • Persistence of fever
    • Presence of focal infection
  • All patients with significant underlying medical conditions, especially any immunodeficiency, require admission for parenteral antibiotics and close observation (see Media file 1).

    Algorithm for the reevaluation of outpatients wit...

    Algorithm for the reevaluation of outpatients with Streptococcus pneumoniae bacteremia.

    [ CLOSE WINDOW ]
    Algorithm for the reevaluation of outpatients wit...

    Algorithm for the reevaluation of outpatients with Streptococcus pneumoniae bacteremia.

Deterrence/Prevention

  • A conjugate heptavalent pneumococcal vaccine was recently (2000) licensed and recommended for routine immunization of young infants. Based on investigational studies, the vaccine reduces invasive pneumococcal disease by 80%.4,5 A recent study also examined the effects of pneumococcal conjugate vaccination on respiratory infections.6

Complications

  • Focal complications
  • Meningitis
  • Sepsis
  • Cellulitis
  • Osteomyelitis
  • Septic arthritis
  • Pneumonia

Prognosis

  • The prognosis for uncomplicated pneumococcal bacteremia generally is excellent with good follow-up and appropriate antibiotic therapy.
  • Pneumococcal meningitis is associated with high morbidity and mortality rates.

Patient Education

  • Parents of patients who are thought to be at risk for pneumococcal bacteremia should be educated properly with standard fever instructions. Parents should seek further care for any of the following reasons:
    • Worsening condition
    • New symptoms
    • Lethargy
    • Irritability
    • Alteration in mental status
    • Signs of dehydration
    • Severe headache
    • Stiff neck
    • Rash

Miscellaneous

Medicolegal Pitfalls

  • Patients with proven pneumococcal bacteremia require careful reevaluation and close follow-up care.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of Richard G Bachur, MD and Marvin Harper, MD, to the original writing and development of this article.



More on Pneumococcal Bacteremia

Overview: Pneumococcal Bacteremia
Differential Diagnoses & Workup: Pneumococcal Bacteremia
Treatment & Medication: Pneumococcal Bacteremia
Follow-up: Pneumococcal Bacteremia
Multimedia: Pneumococcal Bacteremia
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Lynch JP 3rd, Zhanel GG. Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention. Semin Respir Crit Care Med. Apr 2009;30(2):189-209. [Medline].

  2. Picazo JJ. Management of antibiotic-resistant Streptococcus pneumoniae infections and the use of pneumococcal conjugate vaccines. Clin Microbiol Infect. Apr 2009;15 Suppl 3:4-6. [Medline].

  3. Feldman C, Anderson R. Therapy for pneumococcal bacteremia: monotherapy or combination therapy?. Curr Opin Infect Dis. Apr 2009;22(2):137-42. [Medline].

  4. Pneumonia hospitalizations among young children before and after introduction of pneumococcal conjugate vaccine--United States, 1997-2006. MMWR Morb Mortal Wkly Rep. Jan 16 2009;58(1):1-4. [Medline].

  5. Wilkinson M, Bulloch B, Smith M. Prevalence of occult bacteremia in children aged 3 to 36 months presenting to the emergency department with fever in the postpneumococcal conjugate vaccine era. Acad Emerg Med. Mar 2009;16(3):220-5. [Medline].

  6. [Best Evidence] Jansen AG, Sanders EA, Hoes AW, van Loon AM, Hak E. Effects of influenza plus pneumococcal conjugate vaccination versus influenza vaccination alone in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled trial. J Pediatr. Dec 2008;153(6):764-70. [Medline].

  7. Alpern ER, Alessandrini EA, Bell LM, et al. Occult bacteremia from a pediatric emergency department: current prevalence,time to detection, and outcome. Pediatrics. Sep 2000;106(3):505-11. [Medline].

  8. Bachur R, Harper MB. Reevaluation of outpatients with Streptococcus pneumoniae bacteremia. Pediatrics. Mar 2000;105(3 Pt 1):502-9. [Medline].

  9. Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med. Feb 1999;33(2):166-73. [Medline].

  10. Baraff LJ, Oslund S, Prather M. Effect of antibiotic therapy and etiologic microorganism on the risk of bacterial meningitis in children with occult bacteremia. Pediatrics. Jul 1993;92(1):140-3. [Medline].

  11. Black SB, Shinefield HR, Hansen J, et al. Postlicensure evaluation of the effectiveness of seven valent pneumococcalconjugate vaccine. Pediatr Infect Dis J. Dec 2001;20(12):1105-7. [Medline].

  12. Fireman B, Black SB, Shinefield HR, et al. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr Infect Dis J. Jan 2003;22(1):10-6. [Medline].

  13. Greenes DS, Harper MB. Low risk of bacteremia in febrile children with recognizable viral syndromes. Pediatr Infect Dis J. Mar 1999;18(3):258-61. [Medline].

  14. Harper MB, Bachur R, Fleisher GR. Effect of antibiotic therapy on the outcome of outpatients with unsuspected bacteremia. Pediatr Infect Dis J. Sep 1995;14(9):760-7. [Medline].

  15. Harper MB, Fleisher GR. Occult bacteremia in the 3-month-old to 3-year-old age group. Pediatr Ann. Aug 1993;22(8):484, 487-93. [Medline].

  16. Isaacman DJ, Shults J, Gross TK, et al. Predictors of bacteremia in febrile children 3 to 36 months of age. Pediatrics. Nov 2000;106(5):977-82. [Medline].

  17. Kuppermann N. Occult bacteremia in young febrile children. Pediatr Clin North Am. Dec 1999;46(6):1073-109. [Medline].

  18. Kuppermann N, Bank DE, Walton EA, et al. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Arch Pediatr Adolesc Med. Dec 1997;151(12):1207-14. [Medline].

  19. Lee GM, Fleisher GR, Harper MB. Management of febrile children in the age of the conjugate pneumococcal vaccine:a cost-effectiveness analysis. Pediatrics. Oct 2001;108(4):835-44. [Medline].

  20. Lee GM, Harper MB. Risk of bacteremia for febrile young children in the post-Haemophilus influenzae type b era. Arch Pediatr Adolesc Med. Jul 1998;152(7):624-8. [Medline].

  21. Levine DA, Platt SL, Dayan PS, et al. Risk of serious bacterial infection in young febrile infants with respiratorysyncytial virus infections. Pediatrics. Jun 2004;113(6):1728-34. [Medline].

  22. Lieu T, Ray GT, Black S. Cost-effectiveness of pneumococcal vaccine. JAMA. Jul 26 2000;284(4):440-1. [Medline].

  23. Schutze GE, Tucker NC, Mason EO. Impact of the conjugate pneumococcal vaccine in arkansas. Pediatr Infect Dis J. Dec 2004;23(12):1125-9. [Medline].

  24. Sniadack DH, Schwartz B, Lipman H, et al. Potential interventions for the prevention of childhood pneumonia: geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates from children-- implications for vaccine strategies. Pediatr Infect Dis J. Jun 1995;14(6):503-10. [Medline].

  25. Teach SJ, Dryja DM, Tristram D. Pneumococcal bacteremia and focal infection in young children. Clin Pediatr (Phila). Sep 1998;37(9):531-5. [Medline].

  26. Teach SJ, Fleisher GR. Efficacy of an observation scale in detecting bacteremia in febrile children three to thirty-six months of age, treated as outpatients. Occult Bacteremia Study Group. J Pediatr. Jun 1995;126(6):877-81. [Medline].

[ CLOSE WINDOW ]

Keywords

pneumococcal bacteremia, Streptococcus pneumoniae bacteremia, Streptococcus pneumoniae, S pneumoniae, pneumococcus, gram-positive sepsis, occult bacteremia, OB, meningitis, bacteremia, pneumonia, upper respiratory infection, URI, septic arthritis, osteomyelitis, cellulitis, sickle cell disease, HIV, stomatitis, croup, bronchiolitis, varicella, mononucleosis, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Martha L Miller, MD, Associate Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine
Disclosure: Nothing to disclose.

Medical Editor

David Jaimovich, MD, Chief Medical Officer, Joint Commission International and Joint Commission Resources
David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Larry I Lutwick, MD, Professor of Medicine, State University of New York, Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus
Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.