Predictors of Bacteremia Among Children With Sickle Cell Disease Presenting With Fever

Savlov, Deena; Beck, Carolyn E; DeGroot, Julie; Odame, Isaac; Friedman, Jeremy

doi:10.1097/mph.0000000000000070

Cited by 16 publications

(16 citation statements)

References 8 publications

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“…Several studies have previously reported elevated procalcitonin as a marker of SBI in children with SCD and vaso‐occlusive crisis or fever without a source, with different cut‐off levels . Other studies have found elevated CRP, WBC, and neutrophils, older age, toxic appearance, vomiting, and long‐term CVC as predictors of bacteremia . Elevated CRP levels have also been associated with ACS, vaso‐occlusive crisis, and chronic inflammation in these patients …”

Section: Discussionmentioning

confidence: 99%

“…[21][22][23][24][25] Other studies have found elevated CRP, WBC, and neutrophils, older age, toxic appearance, vomiting, and long-term CVC as predictors of bacteremia. 4,11,15,26,27 Elevated CRP levels have also been associated with ACS, vaso-occlusive crisis, and chronic inflammation in these patients. [28][29][30] This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

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Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Rincón-López

Gómez

Matos

et al. 2019

Pediatric Blood & Cancer

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Introduction The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination. Objectives To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low‐risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS). Methods This 11‐year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case‐control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out. Results A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low‐risk factors for CSBI, whereas normal oxygen saturation and C‐reactive protein <3 mg/dl were low‐risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively. Conclusion In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low‐risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Rincón-López

Gómez

Matos

et al. 2019

Pediatric Blood & Cancer

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“…In most developed countries there is low prevalence of BSIs which is largely related to the high vaccine coverage, stringent IPC and antimicrobial stewardship measures. In these countries, Gram positive bacteria causing BSIs predominate among healthy children [8], whereas Salmonella enterica predominate in children with underlying risk conditions like sickle cell disease [26, 27, 34, 35]. On the other hand, low prevalence in a few studies in Tanzania and other LMICs may be due to previous use of antibiotics before admission which in turn lead to culture negative results in the majority of non-neonatal children with community on-set BSIs or improved IPC measures in some hospitals.…”

Section: Discussionmentioning

confidence: 99%

Deciphering risk factors for blood stream infections, bacteria species and antimicrobial resistance profiles among children under five years of age in North-Western Tanzania: a multicentre study in a cascade of referral health care system

et al. 2019

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BackgroundBlood stream infections (BSIs) cause a complex cascade of inflammatory events, resulting in significant morbidity and mortality in children in Tanzania. This study was designed to delineate circulating bacterial species, antimicrobial resistance (AMR) profiles and risk factors for BSIs and mortality among children in the cascade of referral health care facilities so as to guide comprehensive BSIs management.MethodsA multiple cross sectional analytical study was conducted between July 20, 2016 to October 04, 2017 involving 950 children less than five years of age in the North-western part of Tanzania. Children with clinical features suggestive of BSIs were included. Demographic, clinical and laboratory information on culture and antimicrobial susceptibility testing was collected from children; and analyzed using STATA version 13.0 software.ResultsThe prevalence of BSIs among children was 14.2% (95% CI: 12.1–16.6%), with specific prevalence in the district, regional and tertiary hospitals being 8.3, 6.4 and 20.0%, respectively. The most common bacterial pathogens isolated from 135 culture-positive children were Klebsiella pneumoniae (55, 40.4%), Staphylococcus aureus (23, 17.0%), and Escherichia coli (17, 12.6%). Multi-drug resistance (MDR) was higher in isolates from children at Bugando Medical Centre (BMC) tertiary hospital than isolates from district and regional hospitals [OR (95% CI): 6.36 (2.15–18.76); p = 0.001]. Independent risk factors for BSIs were neonatal period [OR (95% CI): 1.93 (1.07–3.48); p = 0.003] and admission at BMC [2.01 (1.08–3.74); p = 0.028)]. Approximately 6.6% (61/932) of children died, and risk factors for mortality were found to be children attending BMC [OR (95% CI): 4.95 (1.95–12.5); p = 0.001)], neonatal period [OR (95% CI): 2.25 (1.02–5.00); p = 0.045)], and children who had blood culture positive results [OR (95% CI): 1.95 (1.07–3.56); p = 0.028)].ConclusionsThe prevalence of BSIs (14.2%) in this multi-centre study is high and predominantly caused by the MDR K. pneumoniae. Priority interventional measures to combat BSIs and mortality, specifically among neonates at BMC are urgently recommended.

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“…The leading organism for bacteremia remained S. pneumoniae despite implementing vaccination and penicillin prophylaxis policies 16 (Supporting Information Table S2). [8][9][10]12,[19][20][21][22][23][24][25][26][27] These data further demonstrate that bacteremia will be identified within 48 h for the overwhelming majority of febrile SCA patients. One patient in our cohort identified with bacteremia after 48 h grew Bordetella holmesii, a rare Gram-negative bacterium that has been identified as a slow growing bacteria in patients with asplenia.…”

Section: Discussionmentioning

confidence: 92%

Outcomes of febrile events in pediatric patients with sickle cell anemia

Sirigaddi

Aban

Jantz

et al. 2018

Pediatric Blood & Cancer

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Predictors of Bacteremia Among Children With Sickle Cell Disease Presenting With Fever

Abstract: In a febrile child with SCD, an ANC>20×10/L, a higher proportion of band cells, and the presence of vomiting were associated with an increased likelihood of bacteremia.

Cited by 16 publications

References 8 publications

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Low‐risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease

Deciphering risk factors for blood stream infections, bacteria species and antimicrobial resistance profiles among children under five years of age in North-Western Tanzania: a multicentre study in a cascade of referral health care system

Outcomes of febrile events in pediatric patients with sickle cell anemia

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