Blood cultures in the management of febrile outpatients later found to have bacteremia

To determine the value of using blood cultures in the detection and prevention of serious focal infections in young febrile outpatients, we reviewed the records of all patients with positive blood cultures for Streptococcus pneumoniae, Haemophilus influenzae type b, or Neisseria meningitidis from January 1971 to June 1983. Of the 482 episodes of bacteremia, 164 (34%) were in children initially managed as outpatients. Of these 164 patients, 20 (12%) either had a serious focal complication subsequently or had persistent bacteremia at follow-up. However, 9 of these 20 children with complications were returned by their parents for reevaluation because of persistent symptoms and signs before the results of the blood cultures were known to clinicians. During the 12 years of the study, four cases of meningitis were detected directly as a result of the positive blood culture. Careful clinical follow-up is critical in the management of febrile outpatients.