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

Abstract

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.

Characterization and Antimicrobial Susceptibility Profile of Septicaemia-Causing Pathogens Isolated From Febrile Children With Sickle Cell Disease in Kano, Nigeria.

“…The prevalence of bacteraemia was 13.8% in febrile SCD positive children attending a tertiary hospital in Ibadan, South West-Nigeria. 17 However, in both studies, Gram-negative bacilli were predominantly the cause of bacteraemia, which is similar to a study conducted in Israel, 18 where an emerging presence of Gram-negative isolates in post-splenectomy patients, including SCD subjects, was reported. The significant difference in prevalence of bacteraemia, especially of Salmonella species , Streptococcus pneumoniae and Klebsiella pneumoniae among febrile SCD positive children recorded in Ibadan 17 and this study could be due to differences in traditional/religion beliefs and cultural practices of the two populations toward SCD, vaccination and general acceptability of hospital at the onset of illness.…”

Sickle Cell Disease and Infections in High- And Low-Income Countries

“…In Africa, bacteremia was found in 14% to 32% in children with SCD. 51–54 This was much higher than the incidence observed in high-income countries 55,56. Reversely, to what is observed in Western countries, pneumococcal infection in Africa does not contribute significantly to the morbidity and mortality of children with SCD because of the involvement of other infections, rending preventive measures inappropriate 57.…”

“…Reversely, to what is observed in Western countries, pneumococcal infection in Africa does not contribute significantly to the morbidity and mortality of children with SCD because of the involvement of other infections, rending preventive measures inappropriate 57. Gram-negative bacteremia constitute more than 60% of all isolates, while the predominant isolates were Klebsiella pneumonia (25%), Staphylococcus aureus (25%), and Salmonella species 51,52,54,58–62. One given explanation for these discrepancies in terms of patterns of bacterial isolates was the unregulated use of antibiotics (mainly penicillins or penicillin derivatives) before hospital admission in some African countries, which could affect the results of bacterial cultures 51,63.…”

Risk of invasive pneumococcal disease in children with sickle cell disease in the era of conjugate vaccines: a systematic review of the literature

“…Most reports included information on penicillin prophylaxis, although adherence was not formally assessed, and all studies reported introduction of a PCV programme except the study from Nigeria, where vaccination uptake was reported to be poor (Brown et al , ). In studies that reported vaccination status, the proportion of IPD cases that were vaccinated with PCV varied significantly from 0% to 80% (Table ).…”

“…pre-or post-PCV era); this study was excluded. The remaining 16 studies were included in the final analysis (Halasa et al, 2007;Adamkiewicz et al, 2008;Rogovik et al, 2010;McCavit et al, 2011;Narang et al, 2012;Baskin et al, 2013;Chang et al, 2013;Ellison et al, 2013;Patel et al, 2013;Payne et al, 2013;Shihabuddin & Scarfi, 2014;Soothill et al, 2016;Brown et al, 2017;Navalkele et al, 2017;Martin et al, 2018;Oligbu et al, 2018). We found large variations in study methodology and quality.…”