The incidence of bacteremia among children and young adults with sickle cell disease (SCD) presenting with pyrexia is low, according to a study published in JAMA Network Open.
SCD can lead to immune system impairment and functional asplenia, causing patients with SCD, especially the very young, to become vulnerable to bacterial infections. Studies indicate that many children under 5 years of age never recover, making bacteremia a significant cause of mortality among pediatric patients.
The implementation of penicillin prophylaxis from the 1980s onward has substantially reduced deaths related to bacteremia among children and young adults with SCD. However, the medical literature is largely silent on the prevalence of bacteremia among SCD patients presenting with fever. The authors of the study sought to assess the risk factors associated with bacteremia in SCD and the clinical outcomes of children and young adults presenting with fever as a medical complaint.
The research team conducted a multicenter retrospective cohort study by accessing the Pediatric Health Information Systems database, which contains data from 50 US pediatric hospitals that is regularly checked to ensure reliability and validity. The researchers focused their attention on patients who were 22 years of age or younger with a diagnosis of SCD presenting with fever. They were able to access demographic information and the type of investigations and interventions that were performed.
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The primary outcome was the percentage of patients who were eventually diagnosed with bacteremia, from presentation until 3 days following discharge. A total of 35,548 emergency department encounters were identified, representing 11,181 young patients with SCD. The authors found that bacteremia was diagnosed in 405 of the 35,548 encounters (371 patients), representing just 1.1% of the total. In addition, they found no significant differences among patients with or without bacteremia in terms of age, sex, SCD genotype, ethnicity/race, and/or type of insurance.
“Prospective studies on children and young adults with SCD presenting with fever are needed to develop decision models and risk stratification tools to refine our approach and avoid unnecessary antibiotic exposure and hospitalization in this population,” the authors concluded.
Rineer S, Walsh PS, Smart LR, Harun N, Schnadower D, Lipshaw MJ. Risk of bacteremia in febrile children and young adults with sickle cell disease in a multicenter emergency department cohort. JAMA Netw Open. Published online June 1, 2023. doi:10.1001/jamanetworkopen.2023.18904