Children presenting with pathogenic bacteria in a blood culture
(bacteremia) manifest a wide spectrum of clinical
signs and symptoms. The continuum from bacteremia to sepsis, severe
sepsis, and septic shock depends on a complex series of interrelated
factors that include the specific etiology, the inoculum of organisms,
strain variations or virulence factors, extracellular components
or toxin production, the site of infection, the immunologic competence
of the host, and the host response to the infection. Bacteremia
may be occult, a transient phenomenon not associated with a specific focus
of infection, or it may result from the extension of an invasive bacterial
infection originating in the genitourinary, gastrointestinal, upper
or lower respiratory tracts, or skin and soft tissues. Specific
secondary infection (meningitis, osteomyelitis, pyelonephritis,
peritonitis, intra-abdominal abscess, or facial cellulitis) may
also occur and affect management. Recurrent or persistent bacteremia
may result from established infectious foci (endocarditis, abscess, foreign-body
infection).