Should blood cultures be obtained in all infants 3 to 36 months presenting with significant fever?

Abstract

Context: Fever without source (FWS) in children 3-36 months is a common presenting complaint. Because of changes in immunization practices and their effects on rates of bacteremia, older guidelines may no longer be applicable. We reviewed the literature regarding the necessity of obtaining a blood culture in non-toxic children in this age group with FWS. Data Sources: We conducted a MEDLINE search on the topic of bacteremia in febrile children 3-36 months from 2004-present. Results: Eight studies were included. Although the studies varied in terms of approach and analysis, all suggested a rate of bacteremia in a non-toxic, febrile child 3-36 months of age to be less than 1%. Conclusions: Strong consideration should be given for foregoing blood culture in a non-toxic child 3-36 months of age with FWS.