Detection and quantitation of bacteremia in childhood

Quantitative blood cultures were sought in 383 children, from whom routine blood cultures were obtained because of fever, by direct plating of 10 and 100 μl blood onto solidified media. There were 14 positive cultures from 12 patients. These were 7 Hemophilus influenzae type b, 5 Streptococcus pneumoniae, and 2 Staphylococcus aureus. The direct-plating technique permitted more rapid identification of positive cultures, and detected three episodes not identified by routine broth culture. Bacterial counts ranged from 20 to >10⁴ bacteria/ml blood. In the three cases of H. influenzae type b meningitis, bacteremia exceeded 10³/ml. Among nine patients in whom bacteremia was unassociated with meningitis, (bacteremia without evident localized disease 5, pneumonia 2, epiglottitis 1, peritonitis 1), bacteremia was <10³/ml. This technique may aid detection of bacteremia and help identify those children at highest risk for developing septic complications, such as meningitis.