Bacterial blood cultures in children with sickle cell disease

Rogovik, Alex L.; Friedman, Jeremy; Persaud, Jeeshan; Goldman, Ran D.

doi:10.1016/j.ajem.2009.04.002

Cited by 23 publications

(31 citation statements)

References 11 publications

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“…Two studies documented high rates of admission of 70% and 77% in 1990 and 2005-2006, respectively, for febrile SCD patients. 12,13 The safety of outpatient management has not been well studied.…”

Section: Discussionmentioning

confidence: 99%

Bacteremia Risk and Outpatient Management of Febrile Patients With Sickle Cell Disease

et al. 2013

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BACKGROUND AND OBJECTIVES: Previous studies have indicated that febrile children with sickle cell disease (SCD) had a 3% to 5% risk of being bacteremic due to compromised immune function. The introduction of routine penicillin prophylaxis and conjugate vaccines may have lowered the risk of bacteremia. Our goals were to determine the rate of bacteremia among children with SCD per febrile episode and to estimate the safety of outpatient management among these febrile SCD patients. METHODS: This 18-year retrospective cohort study included febrile SCD patients who presented to Boston Children’s Hospital between 1993 and 2010. RESULTS: A total of 1118 febrile episodes were evaluated. Nine blood specimens had growth of a pathogen in culture (0.8%; 95% confidence interval: 0.3%–1.3%). Of the 466 febrile patients initially managed as outpatients, 3 were bacteremic (0.6%). All 3 received intravenous ceftriaxone at the initial outpatient visit and returned when contacted after growth of bacteria was detected in the blood culture. Upon return to the hospital, none were “ill appearing,” required supportive care, or were admitted to an ICU. CONCLUSIONS: Our rate of bacteremia among febrile children with SCD is much lower than previous estimates, and there was no associated morbidity or mortality among the patients managed as outpatients. A well-appearing febrile child with SCD may be managed as an outpatient after blood is obtained for bacterial culture and parenteral antibiotics are administered, provided there are no other reasons for admission and the patient is able to return promptly for worsening condition or for growth of a pathogen from their blood culture.

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Section: Discussionmentioning

confidence: 99%

Bacteremia Risk and Outpatient Management of Febrile Patients With Sickle Cell Disease

et al. 2013

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“…Nonetheless, invasive bacterial infections are now rare with current vaccines and penicillin prophylaxis. Recent studies in Canada and the United States have shown that less than 1 % of febrile children with SCD have bacteremia (Rogovik et al 2010 ;Baskin et al 2013 ;Shihabuddin and Scarfi 2014 ).…”

Section: Infectionmentioning

confidence: 99%

Clinical Manifestations of Sickle Cell Anemia: Infants and Children

Nickel

Hsu

2016

Sickle Cell Anemia

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Children with sickle cell disease (SCD) have varied clinical problems. The hallmark manifestation of SCD, the pain crisis, typically fi rst occurs in early childhood presenting as dactylitis. Pain increases in frequency and severity as children age, especially during adolescence. Due to functional asplenia, children with SCD are at signifi cantly increased risk for certain infections, most notably Streptococcus pneumoniae. Other infections like parvovirus B19 are also special threats and can trigger an aplastic crisis. Unique, potentially life-threatening acute complications like splenic sequestration and acute chest syndrome occur in these children. They are at risk for neurologic disease, the most serious being stroke. In addition, the chronic hemolysis of SCD causes gallstones, which can lead to biliary tract disease. Children with SCD also frequently face chronic issues that include nocturnal enuresis and decreased growth. Despite these many potential problems, with advances in care including antibiotic treatment, stroke screening, blood transfusions, and hydroxyurea therapy, children with SCD rarely die in childhood and can become productive adults.

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“…[2][3][4][5] The routine vaccination against Haemophilus influenzae and the introduction of the 7-valent pneumococcal conjugate vaccine (PCV) with the practice of prophylactic oral penicillin have contributed to the decrease of bacteremia in children with SCD. 6,7 A recent study by Rogovik et al 8 showed a low incidence of bacteremia (1.3%) with no growth of Streptococcus species or Haemophilus species.…”

Section: Introductionmentioning

confidence: 97%