Incidence of Serious Bacterial Infections in Febrile Children With Sickle Cell Disease

Bansil, Nelson H; Kim, Tommy Y.; Tieu, Linh; Barcega, Besh

doi:10.1177/0009922813488645

Cited by 34 publications

(43 citation statements)

References 20 publications

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“…Our finding suggests that bacteremia is more common in children with SCD in Nigeria than in developed countries. It is tempting to assume that the lower incidence of bacteremia in London and United States may be due to routine penicillin prophylaxis and vaccinations in those settings 15,16. However, the majority of the etiological agents of bacteremia in the present study were Gram negative organisms especially Klebsiella pneumoniae which corroborates two previous studies in Nigeria 3,17.…”

Section: Discussionsupporting

confidence: 88%

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Prevalence and Aetiology of Bacteremia in Febrile Children With Sickle Cell Disease at a Nigerian Tertiary Hospital

Brown

Dada-Adegbola

Trippe

et al. 2017

Mediterr J Hematol Infect Dis

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Background & ObjectivesAs a result of immune defects in Sickle cell disease (SCD), affected individuals are prone to infection from encapsulated bacterial pathogens like Streptococcus Pneumoniae. Studies on the etiological agents of bacteremia in children with SCD in Nigeria are few and have revealed a spectrum of organisms that is different from those recorded in other parts of the world.Aim and ObjectivesThe objectives of this study were to determine the prevalence of bacteremia, etiological agents and antibiotic susceptibility pattern in febrile children with SCD attending the University College Hospital (UCH), Ibadan, Nigeria.MethodsThe study was cross-sectional and took place at the Department of Pediatrics of the UCH, Ibadan. Children with SCD, ages 0–17 years presenting with axillary temperature ≥ 38°C were enrolled after obtaining informed consent. History was obtained and complete physical examination performed after which blood was collected for culture and antibacterial susceptibility tests.ResultsA total of 116 children were studied of which 69 (59.5%) were males, 111 (95.7%) were of the Hemoglobin SS phenotype and 5 (4.3%) of the Hemoglobin SC phenotype. Bacteremia was present in 16 (13.8%) of the 116 children. Gram negative bacteria constituted 10 (62.5%) of all isolates, while the predominant isolates were Klebsiella pneumoniae 4, (25%) and Staphylococcus aureus, 4 (25%). Over 80% of the isolates were susceptible to Ceftriaxone, Amikacin and Meropenem.ConclusionsKlebsiella pneumoniae and Staphylococcus aureus are the predominant causes of bacteremia in children with SCD in Ibadan, contrary to findings in western countries.

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Section: Discussionsupporting

confidence: 88%

“…The 13.8% incidence observed in this study is higher than 3.4% reported in a retrospective study in London and 1.1% in another retrospective study in the United States of America 15,16. It is however lower than 32.5% reported in Benin City, Nigeria, about two decades earlier 3.…”

Section: Discussioncontrasting

confidence: 76%

Prevalence and Aetiology of Bacteremia in Febrile Children With Sickle Cell Disease at a Nigerian Tertiary Hospital

Brown

Dada-Adegbola

Trippe

et al. 2017

Mediterr J Hematol Infect Dis

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“…In this study, most of the children had been diagnosed by newborn screening (87.3%), which entails a very high percentage of patients with complete vaccination status (94.4%) and receiving penicillin prophylaxis (96.3%) since the first months of life. All these factors probably explain the low rate of CSBI (4.1%) and bacteremia (1.9%) in this cohort, similarly to that in other studies performed in developed countries . We did not find any episodes of confirmed pneumococcal infection, unlike some recent studies that reported cases of invasive pneumococcal disease by serotypes not included in pneumococcal conjugated vaccines .…”

Section: Discussionsupporting

confidence: 82%

“…However, the HGUGM is a reference center of the Madrid area for patients with SCD, so this cohort represents a broad sample of these children for a low‐prevalence country such as Spain and it may be quite representative of the pediatric population with SCD in developed countries. Another limitation of this study was the inclusion of all episodes of ACS in the possible SBI group, similarly to what has been done in other studies, because of the difficulty of excluding bacterial pneumonia or a viral‐bacterial coinfection in cases of ACS. However, to solve this possible bias, we analyzed separately the low‐risk factors for CSBI and ACS.…”

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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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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“…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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Incidence of Serious Bacterial Infections in Febrile Children With Sickle Cell Disease

Abstract: We had an incidence of 16.0% for serious bacterial infections in febrile children with sickle cell disease, with the majority of patients diagnosed with pneumonia.

Cited by 34 publications

References 20 publications

Prevalence and Aetiology of Bacteremia in Febrile Children With Sickle Cell Disease at a Nigerian Tertiary Hospital

Prevalence and Aetiology of Bacteremia in Febrile Children With Sickle Cell Disease at a Nigerian Tertiary Hospital

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

Outcomes of febrile events in pediatric patients with sickle cell anemia

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