Rates of positive blood, urine, and cerebrospinal fluid cultures in children younger than 60 days during the vaccination era.

BACKGROUND: Fever is a common reason children present to the emergency department. The goal of this study was to determine the rates and the etiology of bacterial infection in children younger than 2 months during the vaccination era.
METHODS: This is a retrospective chart review performed at a tertiary care hospital. Electronic medical records were used to identify patients who had a workup for fever/sepsis in the emergency department. The search was limited to identifying only children younger than 60 days.
RESULTS: A total of 207 patients satisfied the inclusion/exclusion criteria. In children younger than 28 days, the blood culture-positive rate was 2.7% (range, 0.0%-6.4%), the urine culture-positive rate was 10.7% (range, 3.5%-17.8%), and the cerebrospinal fluid-positive rate (excluding enteroviral infections) was 0% (range, 0.0%-3.9%). In children 29 to 60 days, the blood culture-positive rate was 1.5% (range, 0.0%-3.6%), urine culture-positive rate was 8.5% (range, 3.7%-13.3%), and the cerebrospinal fluid-positive rate (excluding enteroviral infections) was 1.7% (range, 0.0%-5.0%). Urinary tract infections due to Escherichia coli were very common, whereas no cases of Haemophilus influenzae and one case of Streptococcus pneumoniae were detected.
CONCLUSIONS: Urinary tract infections due to E. coli are very common in this age group. The classic pathogens H. influenzae and S. pneumoniae were essentially nonexistent in this study possibly because of herd immunity obtained through current vaccination practices.