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

Abstract

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.

Interleukin 6 as a Marker of Severe Bacterial Infection in Children with Sickle Cell Disease and Fever: A Case-Control Study

“…Despite the low proportion of con rmed SBI in this cohort, almost all patients received at least one dose of antibiotic (96.2%), in agreement to current guidelines [18][19][20].This high use of antibiotics emphasizes the importance of de ning laboratory parameters that could early discriminate the etiology of fever in these patients, in order to optimize the antimicrobial prescription. Children with SBI presented more frequently with hemodynamic instability and had higher in ammatory parameters (neutrophils, CRP and procalcitonin) than the rest of the patients, similarly to what was described in other studies [1,[5][6][7][8][9]. We also found that children with SBI had signi cantly higher IL-6 levels when compared with those with VI, NPI and controls, with the highest value observed in the only patient with con rmed pneumococcal pneumonia.…”

Improvement of Sickle Cell Disease Morbimortality in Children: Experience in a Remote Area of an African Country

“…The [58][59][60][61][62][63][64][65][66]. Prospective cohort studies of SCD patients are rare in Africa due to barriers to medical monitoring [37].…”

Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease

“…Previous studies using different cut-off levels [13][14][15][16] with a high negative predictive value reported elevated procalcitonin as a marker of severe bacterial infection in patients with SCD and vaso-occlusive crisis. Our results are in accordance with trials performed either in emergency departments [9,[17][18][19] or in primary care [20] to reduce antibiotic exposure.…”

“…Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14][15][16][17][18] vs. 13 [13,14] days (p = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (p = 0.01).…”