Prevalence of Bacteremia in Febrile Patients With Sickle Cell Disease: Meta-Analysis of Observational Studies

Outcome of Pediatric Patients With Sickle Cell Anemia Admitted With Fever: A Retrospective Single-Center Study

BACKGROUND

Pediatric patients with sickle cell anemia (SCA) are known to have an increased susceptibility to infections, leading to a higher incidence of fever among this population. However, there is limited literature specifically focusing on the outcomes of pediatric SCA patients presenting to the emergency department (ED) or hospital with a primary diagnosis of fever.

OBJECTIVES

The objective of this retrospective single-center study was to compare the characteristics of fever and associated symptoms among pediatric patients with SCA, and to investigate the risk factors associated with patients' outcomes and mortality in this specific population.

PATIENTS AND METHODS

The study was conducted at the King Salman Medical City, Maternity and Children's Hospital, Medina, Saudi Arabia, during the period from 2017 to 2022. All pediatric SCA patients under the age of 14, who presented to the ED of the hospital during the study period with a primary diagnosis of fever, were included. The study collected and analyzed clinical, laboratory, treatment, complications, and outcome data of the patients using appropriate statistical methods, including logistic regression.

RESULTS

A total of 57 children were included in the analysis. The mean age of the patients was 7.1 ± 4.3 years, with 26 males (45.6%) and 31 females (54.4%). Among the cases, 8 (14%) exhibited fever along with gastrointestinal symptoms, 18 (31.6%) presented with musculoskeletal symptoms, 5 (8.8%) showed neurological symptoms, and approximately half of the cases (45.6%) displayed respiratory symptoms along with fever. Logistic regression analysis identified several significant factors associated with complications in this sample, including a very low level of hemoglobin (Hb) (<7 g/dL) with an odds ratio (OR) of 14.5 (95% CI=1.03-222.3), ICU admission with OR of 14 (95% CI=1.03-186.8), and a hospital stay duration of more than 10 days (OR=11.5; 95% CI=1.10-121.3). Additionally, fever associated with neurological symptoms, neutrophilia, history of splenectomy, and male sex showed positive associations with complications among the studied patients, although not significant.

CONCLUSION

This study provides valuable insights into the characteristics and outcomes of febrile pediatric patients with SCA. The findings highlight the importance of early recognition and management of fever in this vulnerable population, particularly when certain risk factors are present.

[Lung manifestations of sickle-cell disease]

Sickle-cell disease is an autosomal recessive genetic disorder of hemoglobin that causes systemic damage. Hypoxia is the main actor of sickle-cell disease. It initiates acutely the pathogenic cascade leading to tissue damages that in turn induce chronic hypoxia. Lung lesions represent the major risk of morbidity and mortality. Management of sickle-cell disease requires a tight collaboration between hematologists, intensivists and chest physicians. Recurrent episodes of thrombosis and hemolysis characterize the disease. New therapeutic protocols, associating hydroxyurea, transfusion program and stem cell transplantation in severe cases allow a prolonged survival until the fifth decade. However, recurrent pain, crisis, frequent hospital admissions due to infection, anemia or acute chest syndrome and chronic complications leading to organ deficiencies degrade the patients' quality of life. In low-income countries where the majority of sickle-cell patients are living, the disease is still associated with a high mortality in childhood. This paper focuses on acute chest syndrome and chronic lung manifestations.

Risk-score based strategy to minimize antibiotic exposure in children with sickle cell disease and fever

Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7–7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83–0.96) for the prediction of confirmed SBI and 0.86 (0.77–0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score-based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.

Frequency of bacteremia in patients with sickle cell disease: a longitudinal study

Bacterial infections in sickle cell disease (SCD) are associated with major risks of morbidity and mortality. Here, we describe the occurrence of bacteremia in SCD patients from 2000 to 2017. This is an observational study which included children and adults with SCD and fever and had confirmed positive blood cultures. During the study period, there were 1095 SCD patients with 17,053 blood cultures. Of all the patients, 699 (63.8%) were children and 396 (36.2%) adults with 576 (52.6%) males and 519 (47.4%) females. The mean age ± SD was 17.8 (± 14.7), and a median age (IQR) of 13.6 (6.8-23.5) years. The mean (SD) follow up was 7.4 (5.4) years and the total number of patient-years was 8069.1 years. Out of the 1095 patients, 91 (8.3%) had bacteremia with 35 (38.5%) children and 65 (61.5%) adults (p = .079). The rate of bacteremia in all patients, children, and adults were 1.5 (95% CI: 1.3-1.8), 0.6 (95% CI: 0.4-0.8), and 2.4 (95% CI: 1.8-3.1) per 100 patient-years, respectively. The risk of Gram-positive bacteremia was 0.5 (96% CI: 0.36-0.69) in all patients, 0.1 (95% CI: 0.06-0.20) in children, and 1.4 (95% CI: 1.0-2.0) in adults per 100 patient-years. The risk of Gram-negative bacteremia was 1.0 (95% CI: 0.81-1.3) in all patients, 0.6 (95% CI: 0.4-0.8) in children, and 2 (95% CI: 1.5-2.7) in adults per 100 patient-years. The risk of Gram-negative bacteremia was higher than Gram-positive bacteremia in children (p < .001) but not in adults (p = .113) and adults had higher risk in general than children. In this study of SCD cohort, 8.3% had bacteremia with predominant Gram-negative infections. Bacteremia was more frequently encountered in the adult age group. Further studies are needed to verify the findings and explore possible reasons predisposing SCD patients to bacteremia.