Annotated bibliography of occult bacteremia

In the years that clinical investigators have been examining the essential questions regarding occult bacteremia, it was assumed that refinements in evaluation and treatment would spare more children infectious sequelae while testing fewer children unnecessarily. Several important features of this clinical entity that contradict that philosophy are now clear. The incidence of occult bacteremia in the defined population is small - less than 5%. Blood cultures do not always identify children with occult bacteremia expeditiously. Children with higher temperatures and WBC counts are more likely to have occult bacteremia, but there is no temperature and WBC count cutoff where bacteremia does not occur. Infectious sequelae continue to occur despite a number of aggressive treatment regimens available. Venipuncture and laboratory testing are always expensive and undesirable for the pediatric patient. In the final analysis, there is still no substitute for rigorous clinical follow-up. It is clear that when the well-appearing child with fever becomes the symptomatic or ill-appearing child with fever, intervention can be lifesaving. Therefore, we can restate the philosophy that rigorous follow-up evaluation avoids testing and treating entirely, spares hundreds of children discomfort, and identifies and treats those children who develop infectious sequelae in no less time than waiting for blood culture results. Perhaps this should be the focus of future clinical investigations.