1. Predictors of occult pneumococcal
bacteremia in young febrile children in the
era of pneumococcal conjugated vaccine
Mintegi Raso S, Benito Fernández J, Iturralde Orive I, Dopazo L
Paediatric Emergency Department. Hospital Cruces. Bilbao. Basque Country
3. Background
• Changes in PnOB prevalence and
distribution of serotypes due to PCV-7
may have altered the yield of complete
blood count (CBC) in order to select
patients at risk of having PnOB.
4. Objective
• To analyze the yield of the CBC in order to
identify children at risk for PnOB in the era
of PCV-7.
5. Methods
• Retrospective review
– Well appearing children 3 to 36 months of age, FWS
– presenting to the PED of a tertiary teaching hospital
(Hospital Cruces, Basque Country)
– October 1, 2004 and September 30, 2006
– CBC and a blood culture (BC) performed as part of
their evaluation for fever
• Patients with altered urinanalysis were excluded.
• n=1586
6. Results
• Positive blood culture :
– 16 children 1%
– Pneumococcus 11 0.7%
salmonella enteritidis 1
enterococcus faecium 1
group A Streptococcus 1
meningococcus B 2
Streptococcus pneumoniae 11
8. Results – PCV7-bacteremia rate
Doses of PCV-7
933
157 208 161
60 67
None 1 2 3 4 Unknown
Doses of PCV-7 PnOB rate
Less than 2 0.82%
2 or more 0.23%
9. Results – PPV related with doses
of PCV-7
WBC > 15000. PnOB PPV
ANC > 10000. PnOB PPV
1,8
2
0,9
0,6
less than 2 2 or more 0-1 dosis >2dosis
PCV-7 doses PCV-7 doses
10. Limitations
• Retrospective study
• Not-multicenter
• Inclusion only of those well-appearing
children aged 3 to 36 months with FWS ≥
39ºC, in which physician obtained a CBC
and blood culture as part of their
evaluation for fever
11. Conclusions
• In the era of PCV-7, rate of PnOB is
different in children related with the
pneumococcal vaccination status.
• The yield of the CBC is lower than in the
pre-vaccinal era.
• Decisions based on the analytical results
must be reconsidered, mainly in the
infants with at least 2 doses of VCN.
