Jundishapur Journal of Health Sciences

Jundishapur Journal of Health Sciences

Bacterial Etiology of Occult Bacteremia in Febrile Children (3–36 Months) in Southwest Iran Using Blood Culture and PCR

Document Type : Research Article

Authors
Ahmad Shamsizadeh 1, 2
Roya Nikfar 2
Ziba Rezajou 2
AzarDokht Khosravi 3, 4
Bahman Cheraghian 5
Maniya Arshadi* 3, 4
1 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran2. Abuzar Children's Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
2 Abuzar Children's Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
5 Department of Biostatistics and Epidemiology, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
10.22118/jjhs.2025.229895
Abstract
Background and Objective: The aim of this study was to investigate the common causes of bacterial fever in children aged 3 to 36 months suspected of occult bacteremia using blood culture and PCR methods.
 
Methods: We analyzed 120 children referred to Aboozar Hospital of Ahvaz, Iran. Blood samples were subjected to culture and PCR, and demographic and laboratory data (WBC, ESR, CRP) were recorded.
 
Findings: Blood culture result was positive in two patients (1.7%). The number of patients with definite positive PCR was 20 (16.66%). There was no significant difference between the mean values of WBC and neutrophil in positive and negative bacteremia. Mean values of ESR in bacterial positive cases were significantly higher compared with the negative ones. The percentage of patients with a history of antibiotic use was higher in the positive bacteremia group (55%) compared to the negative bacteremia group (46%), but no significant difference was observed.
 
Conclusion: While laboratory markers like WBC and neutrophil counts have limited accuracy in predicting bacteremia, the PCR method offers a more reliable alternative for diagnosing causative organisms. This is particularly relevant given the clinical presentation of patients, where traditional lab values may not be sufficient for diagnosis.
Footnotes
Acknowledgments
This study was part of a dissertation for a specialty degree in pediatric diseases. It was financially supported by the Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (grant No. OG-95113)
 
Conflict of Interests Statement
The authors declare no conflict of interest. Data Availability: All data generated or analyzed during this study will be available from the corresponding author on reasonable request.
 
Data Availability
All data generated or analyzed in this study are available from the corresponding author upon reasonable request.
 
Funding/Support
This research was financially supported by the Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (grant No.OG.95513).
 
Ethical Approval
The study was approved by the Ethical Committee of Ahvaz Jundishapur University of Medical Sciences, Iran. IR.AJUMS.REC.1395.252).
 
Authors' Contribution

A. Sh. And R.N. developed the study concept and design. Z.R. acquired the data. B.Ch., A. Kh and M.A analyzed and interpreted the data, and wrote the first draft of the manuscript. All authors contributed to the intellectual content, manuscript editing and read and approved the final manuscript. M.A. and A.Sh. provided administrative support.

 
Informed Consent
Informed consent was obtained from the participants.
 
Keywords
Occult bacteremia
PCR
Blood Culture
FWLS
  1. Bilavsky E, Yarden‐Bilavsky H, Ashkenazi S, Amir J. C‐reactive protein as a marker of serious bacterial infections in hospitalized febrile infants. Acta paediatrica. 2009;98(11):1776-80. https://doi.org/10.1111/j.1651-2227.2009.01469.x
  2. Lacroix L, Manzano S, Vandertuin L, Hugon F, Galetto-Lacour A, Gervaix A. Impact of the lab-score on antibiotic prescription rate in children with fever without source: a randomized controlled trial. PLoS One. 2014;9(12):e115061. https://doi.org/10.1371/journal.pone.0115061
  3. Chancey R, Jhaveri R. Fever without localizing signs in children: a review in the post-Hib and postpneumococcal era. Minerva pediatrica. 2009;61(5):489-501. https://pubmed.ncbi.nlm.nih.gov/19794375/
  4. Arora R, Mahajan P. Evaluation of child with fever without source: review of literature and update. Pediatric Clinics. 2013;60(5):1049-62. https://doi.org/10.1016/j.pcl.2013.06.009
  5. Phasuk N, Nurak A. Etiology, treatment, and outcome of children aged 3 to 36 months with fever without a source at a community hospital in Southern Thailand. Journal of Primary Care & Community Health. 2020;11:2150132720915404. https://doi.org/10.1177/2150132720915404
  6. Buendía JA, Bedoya M, Benjumea-Bedoya D. Occult bacteraemia in children with fever without focus though previously vaccinated against pneumococcus. Tropical Doctor. 2022:00494755221092936. https://doi.org/10.1177/00494755221092936
  7. Bang A, Chaturvedi P. Yale Observation Scale for prediction of bacteremia in febrile children. The Indian Journal of Pediatrics. 2009;76(6):599-604.

 https://doi.org/10.1007/s12098-009-0065-6

  1. Barg AA, Kozer E, Mordish Y, Lazarovitch T, Kventsel I, Goldman M. The risk of serious bacterial infection in neutropenic immunocompetent febrile children. Journal of Pediatric Hematology/Oncology. 2015;37(6):e347-e51. https://doi.org/10.1097/MPH.0000000000000345
  2. Gomez B, Hernandez-Bou S, Garcia-Garcia J, Mintegi S. Bacteremia in previously healthy children in emergency departments: clinical and microbiological characteristics and outcome. European Journal of Clinical Microbiology & Infectious Diseases. 2015;34(3):453-60. https://doi.org/10.1007/s10096-014-2247-z
  3. Berezin EN, Iazzetti MA. Evaluation of the incidence of occult bacteremia among children with fever of unknown origin. Brazilian journal of infectious diseases. 2006;10:396-9. https://doi.org/10.1590/s1413-86702006000600007
  4. Ombelet S, Barbé B, Affolabi D, Ronat J-B, Lompo P, Lunguya O, et al. Best practices of blood cultures in low-and middle-income countries. Frontiers in medicine. 2019;6:131.
  5. Park C-W, Han J-H, Jeong J-H, Cho S-H, Kang M-J, Tae K, et al. Detection rates of bacteria in chronic otitis media with effusion in children. Journal of Korean medical science. 2004;19(5):735-8. https://doi.org/10.3346/jkms.2004.19.5.735
  6. Baethgen LF, Moraes C, Weidlich L, Rios S, Kmetzsch C, Silva MSNd, et al. Direct-test PCR for detection of meningococcal DNA and its serogroup characterization: standardization and adaptation for use in a public health laboratory. Journal of medical microbiology. 2003;52(9):793-9. https://doi.org/10.1099/jmm.0.05192-0
  7. Amit-Romach E, Sklan D, Uni Z. Microflora ecology of the chicken intestine using 16S ribosomal DNA primers. Poultry science. 2004;83(7):1093-8. https://doi.org/10.1093/ps/83.7.1093
  8. Perez-Roth E, Claverie-Martın F, Villar J, Mendez-Alvarez S. Multiplex PCR for simultaneous identification of Staphylococcus aureus and detection of methicillin and mupirocin resistance. Journal of clinical microbiology. 2001;39(11):4037-41. https://doi.org/10.1128/JCM.39.11.4037-4041.2001
  9. Wilkinson M, Bulloch B, Smith M. Prevalence of occult bacteremia in children aged 3 to 36 months presenting to the emergency department with fever in the postpneumococcal conjugate vaccine era. Academic Emergency Medicine. 2009;16(3):220-5. https://doi.org/10.1111/j.1553-2712.2008.00328.x
  10. Elhassanien AF, Hesham A-AA, Alrefaee F. Fever without source in infants and young children: dilemma in diagnosis and management. Risk Management and Healthcare Policy. 2013;6:7. https://doi.org/10.2147/RMHP.S40553
  11. Mekitarian Filho E, Carvalho WBd. Current management of occult bacteremia in infants. Jornal de Pediatria. 2015;91:S61-S6. https://doi.org/10.1016/j.jped.2015.06.004
  12. Moradi-Lakeh M, Shakerian S, Esteghamati A. Immunization against Haemophilus influenzae type b in Iran; cost-utility and cost-benefit analyses. International journal of preventive medicine. 2012;3(5):332. https://pubmed.ncbi.nlm.nih.gov/22708030/
  13. Gómez B, Mintegi S, Benito J, Egireun A, Garcia D, Astobiza E. Blood culture and bacteremia predictors in infants less than three months of age with fever without source. The Pediatric infectious disease journal. 2010;29(1):43-7. https://doi.org/10.1097/INF.0b013e3181c6dd14
Jundishapur Journal of Health Sciences
Volume 17, Issue 3
Summer 2025
Pages 33-39