Audio Only

Objectives
Occult Bacteremia in the 21st Century: Should We Still Be Concerned?
Case Presentation
Case Presentation
Management Questions
Management Questions
Management Survey: 16 mo with fever
Framework
Organisms: Pre 1990
Organisms: Post 1990
Question
Comic
Febrile Status
Lab Tests
Comic
WBC
What To Do, What To Do?
Management Practices
Practice Guidelines: Baraff (1993)
Sarah Long’s Response (1994)
Sarah Long’s Response
Recent Developments
Declining Incidence of HIB Disease
Declining Incidence of HIB Disease
Emphasis on Resource Utilization
New Techniques for Rapid Identification of Bacteremia
Lab Delay: Joffe & Avner (1990)
New Techniques for Rapid Identification of Bacteremia
Logistic Regression: Isaacman (2000)
New Techniques for Rapid Identification of Bacteremia
Consideration of Parental Values
Consideration of Parental Values
Caregiver Worry About Fever
Usefulness of Antibiotics to Prevent Serious Sequelae Unclear
Usefulness of Antibiotics to Prevent Serious Sequelae Unclear
Cost-Effectiveness Analysis (Lee 2001)
Cost-Effectiveness Analysis (Lee 2001)
Increasing Antibiotic Resistance
Ceftriaxone
Comic
Comic
What’s The Big Deal?
Principles of
Parental Pressure
Fever
Fever
Fever
Fever
Fever
Fever Phobia
Pneumococcal Vaccine
Rate of Invasive Pneumococcal Disease by Age Group (US, 1998)
Pneumococcal Vaccine
Pneumococcal Vaccine
Pneumococcal Vaccine
Changing Risk of Occult Bacteremia?
Calvin and Hobbes
Image
Slide38
Differences in Management Strategies
What I Do
Where Are We?
Stars
Graphic

Jeffrey Avner, M.D.

Occult Bactermia in the 21st Century: Should we still be concerned?