Prevalence of SBI in children with sickle cell disease continues to decline

Only 3.6% of fully vaccinated febrile children with sickle cell disease (SCD) who visited an emergency department were found to have a serious bacterial infection (SBI) meriting hospitalization, according to a retrospective study in Saudi Arabia.

Investigators screened medical records associated with 833 febrile events, resulting in 40 study participants with positive bacterial culture results from various body fluids. The authors assessed the 30 febrile events for the remaining children and concluded that their hospitalization was justified. All these children were younger than 12 years and had received recommended vaccinations, including 13-valent pneumococcal conjugate vaccine, quadrivalent meningococcal conjugate vaccine, and Haemophilus influenzae type b vaccine, as well as regular penicillin prophylaxis. Additionally, most (57%) participants were male.

Urinary tract infection was the most prevalent SBI, seen in 2.2% of participants, followed by bacteremia (1.3%), osteomyelitis (0.24%), and meningitis (0.12%). Pneumococcus was the most common organism associated with bacteremia (46%), followed by Salmonella species (36%). All the children recovered.

The authors concluded that as the prevalence of SBI continues to decline in patients with SCD, ambulatory management using empirical antibiotics often is appropriate.

Thoughts from Dr. Farber

Before we had the many immunizations now available, as well as ceftriaxone, febrile children with SCD were hospitalized for several days routinely, regardless of how well they appeared. This study offers further support for treating such children as outpatients, provided they do not appear toxic and one can establish good follow-up.

Reference

Frequency of serious bacterial infection among febrile sickle cell disease children in the era of the conjugate vaccine: A retrospective study. International Journal of Pediatrics and Adolescent Medicine. Published online May 31, 2022. doi:10.1016/j.ijpam.2022.05.002