Pathophysiology

Children between the ages of birth and 3 years old are at relatively increased risk for bloodborne bacterial disease due to immaturity of the reticuloendothelial system. The term bacteremia refers to the presence of a positive blood culture without reference to specific clinical symptomatology. Bacteremia may resolve spontaneously, progress to septicemia, or be associated with focal serious bacterial infection (SBI), most often involving the meninges, lung, kidney, bowel, bone, or joint.

The risk of bacteremia decreases with age, with the highest incidence in the first 3 months of life ( Table 1J..8-1). Neonates with fever, defined as a rectal temperature of 38.0°C or higher, have a 5 percent risk for bacteremia and 15 percent incidence of SBI due to pathogens encountered at the time of birth. 12 and 3 Bacteremia in this age group either results in a fulminant septicemic process within hours to days of birth ( early-onset disease) or a focal SBI developing weeks to months later (late-onset disease). Group B Streptococcus is by far the most common bacterial pathogen in this age group, followed by Escherichia coli, Listeria monocytogenes, and Enterococcus sp. Infants aged 30 to 90 days are at a progressively lesser risk for late-onset infection from these neonatally acquired pathogens but are increasingly susceptible to community-acquired pathogens. This age group thus represents a transition period from neonates and those infants aged 3 months and older.

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