Why is routine screening for occult bacteremia in immunocompetent children with fever strongly discouraged?

Updated: Jul 23, 2019
  • Author: Hina Z Ghory, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Answer

The routine acquisition of CBC and/or blood cultures to screen for occult bacteremia in immunocompetent children is strongly discouraged for the following reasons:

  • The peripheral white blood cell count has a low positive predictive value for bacteremia

  • Bacteremia rates are less than 1% in the postpneumococcal vaccine era [58, 13, 63]

  • Bacteremia spontaneous resolution rates (without antibiotics) are greater than 90%; therefore, few children with pneumococcal bacteremia develop complications [81, 82]

  • High false-positive blood culture rates from contamination leads to unnecessary testing and/or hospitalizations

  • Indiscriminate testing is costly and invasive


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