Occult bacteremia etiology following the introduction of 13-valent pneumococcal conjugate vaccine: a multicenter study in Spain
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Little is known about occult bacteremia (OB) in Spain following the introduction of the 13-valent pneumococcal conjugated vaccine (PCV13). Our aim was to describe the microbiologic characteristics and management of OB among children aged 3–36 months in Spain in the era of PCV13. Data were obtained from a multicenter registry of positive blood cultures collected at 22 Spanish emergency departments (ED). Positive blood cultures performed on patients aged 3–36 months from 2011 to 2015 were retrospectively identified. Immunocompetent infants with a final diagnosis of OB were included. Non-well-appearing patients and patients with fever > 72 h were excluded. We analyzed 67 cases (median age 12.5 months [IQR 8.7–19.4]). Thirty-seven (54.4%) had received ≥ 1 dose of PCV. Overall, 47 (70.1%) were initially managed as outpatients (38.3% of them with antibiotic treatment). Phone contact was established with 43 (91.5%) of them after receiving the blood culture result and 11 (23.4%) were hospitalized with parenteral antibiotic. All patients did well. Streptococcus pneumoniae was isolated in 79.1% of the patients (42.2% of the isolated serotypes were included in the PCV13). S. pneumoniae remains the first cause of OB in patients attended in the ED, mainly with non-PCV13 serotypes. Most of the patients with OB were initially managed as outpatients with no adverse outcome.
KeywordsOccult bacteremia Emergency department Fever without source Infants Pneumococcal conjugated vaccine
We gratefully acknowledge the contribution of the members of the Bacteraemia Study Working Group of the Infectious Diseases Working Group of the Spanish Society of Pediatric Emergencies. The 22 participating centers and their researchers were as follows:
Hospital Sant Joan de Déu Barcelona (Carla Pascual), Hospital Universitari Vall D’Hebrón (Nuria Worner, Susana Melendo), Niño Jesús Children’s University Hospital (Mercedes de la Torre, Mercedes Alonso), Cruces University Hospital (Iker Gangoiti, Usune González), Canaries University Hospital Maternity Ward (Sara García), Son Espases University Hospital (Carmen Pérez, Enrique Ruiz de Gopegui), Hospital Universitario 12 de Octubre (Sofía Mesa, María Ángeles Orellana), Príncipe de Asturias University Hospital (María Ángeles García, Peña Gómez), Corporació Sanitària Parc Taulí. Hospital de Sabadell. Institut Universitari Parc Taulí - UAB (Laura Marzo, Dionisia Fontanals), Basurto University Hospital (María Landa, José Luis Díaz de Tuesta), Cabueñes Hospital (Ramón Fernández, Begoña Fernández), Althaia. Xarxa Assistencial Universitària de Manresa (Zulema Lobato, Montse Morta), Mendaro Hospital (Laura Herero, Yosune Mendiola), Hospital Moncloa (Juana Barja, Rodolfo Luján), Alto Deba General Hospital (Goizalde López, Ainara Rodríguez), Hospital Universitario Virgen de la Arrixaca (José Rodríguez, Ana Blázquez), Hospital Universitario Infanta Sofía (Alfredo Tagarro, Esteban Aznar), Hospital Universitari Sant Joan de Reus (Neus Rius), Hospital General de Catalunya (Esther Oliva), Hospital Universitario Reina Sofía (Francisca Aguilar, Angela Bello), Hospital Universitario Río Hortega (María Nathalie Campo, Juncal Mena), Hospital del Tajo (Clara García-Bermejo).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethical Committee of the Basque Country, under whose auspices the coordinating institution operates. Approval for the study and for data sharing with the coordinating institution and with the centralized data center was granted by the institutional review board at each participating institution.
For this type of study, formal consent is not required.
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