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. 2022 Jan 1;149(1):e2021051892.
doi: 10.1542/peds.2021-051892.

Bloodstream Infections in Children With Sickle Cell Disease: 2010-2019

Marianne E Yee  1   2 , Kristina W Lai  1 , Nitya Bakshi  1   2 , Joanna K Grossman  1   2 , Preeti Jaggi  2 , Alexander Mallis  1 , Yun F Wang  3   4 , Robert C Jerris  5   3 , Peter A Lane  1   2 , Inci Yildirim  2   6   7
Affiliations

Bloodstream Infections in Children With Sickle Cell Disease: 2010-2019

Marianne E Yee et al. Pediatrics. .

Abstract

Background: Children with sickle cell disease (SCD) are at increased risk for bloodstream infections (BSIs), mainly because of functional asplenia. Immunizations and antibiotic prophylaxis have reduced the prevalence of invasive bacterial infections, but contemporary analysis of BSI in children with SCD is limited.

Methods: We conducted a retrospective cohort study of children aged <18 years with SCD who had blood cultures collected at our institution from 2010 to 2019 to identify BSI. Probable contaminant organisms were identified and not included as BSI. We calculated the annual incidence of BSI at our institution with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations.

Results: There were 2694 eligible patients with 19 902 blood cultures. Excluding repeated cultures and contaminant cultures, there were 156 BSI episodes in 144 patients. The median age at BSI was 7.5 years. The average incidence rate of BSI was 0.89 per 100 person-years (95% CI 0.45-1.32). The most common pathogens were Streptococcus pneumoniae (16.0%), Streptococcus viridans group (9.0%), Escherichia coli (9.0%), Staphylococcus aureus (7.7%), Bordetella holmesii (7.7%), Haemophilus influenzae (7.1%), and Salmonella species (6.4%). Odds of BSI were higher with sickle cell anemia genotypes (odds ratio [OR] 1.88; 95% CI 1.20-2.94) and chronic transfusions (OR 2.66; 95% CI 1.51-4.69) and lower with hydroxyurea (OR 0.57; 95% CI 0.39-0.84).

Conclusions: BSI remains a risk for children with SCD. Overall incidence, risk factors, and spectrum of pathogens are important considerations to guide prevention and empirical treatment of suspected infection in SCD.

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Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Flow diagram for identification of BSIs among a cohort of children with SCD, 2010–2019. HSCT, hematopoietic stem cell transplant.
FIGURE 2
FIGURE 2
Annual incidence rates of BSI episodes among children with SCD, 2010–2019. SPN, S pneumoniae.
FIGURE 3
FIGURE 3
Antimicrobial susceptibility testing among isolates of S pneumoniae, Salmonella, and E coli.
See this image and copyright information in PMC

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