Bacteremia rare in children with sickle cell disease presenting with fever: JAMA

A recent study found that the absolute risk of bacteremia in children and young adults with sickle cell disease (SCD) presenting to the emergency department (ED) with fever is low. The findings were published in Journal of Medical Association.

The study by Stephen Rineer and team analyzed data from the Pediatric Health Information Systems database, spanning from January 2016 to December 2021, involving 35,548 encounters representing 11,181 individual patients from 36 hospitals. The cohort had a median age of 6.17 years, and 52.9% were male. The researchers found that the absolute risk of bacteremia in these individuals with SCD presenting with fever was relatively low, occurring in only 1.1% of the encounters.

Several patient-level factors were examined, and it was observed that a history of invasive bacterial infections, such as osteomyelitis or stroke, as well as central line-associated bloodstream infection (CLABSI), central venous catheter use, and apheresis were significantly associated with the diagnosis of bacteremia. Interestingly, age, sex, hemoglobin SC genotype, and race and ethnicity did not show a significant association with bacteremia.

In the multivariable analysis, individuals with a history of bacteremia had a 36% higher odds of developing bacteremia. Additionally, those with CLABSI had a strikingly higher odds ratio of 6.39, while individuals who underwent apheresis had 77% higher odds of bacteremia. These findings highlight the importance of recognizing the history of invasive bacterial infections, CLABSI, and apheresis as potential risk factors for bacteremia in children and young adults with SCD.

Understanding the risk factors associated with bacteremia can aid healthcare providers in identifying high-risk individuals who may require more vigilant monitoring and targeted interventions. By recognizing the significance of a history of invasive bacterial infections, CLABSI, and apheresis, healthcare professionals can take proactive measures to prevent, diagnose, and manage bacteremia in children and young adults with SCD presenting with fever.

Source:

Rineer, S., Walsh, P. S., Smart, L. R., Harun, N., Schnadower, D., & Lipshaw, M. J. (2023). Risk of Bacteremia in Febrile Children and Young Adults With Sickle Cell Disease in a Multicenter Emergency Department Cohort. In JAMA Network Open (Vol. 6, Issue 6, p. e2318904). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.18904