Marianne E Yee1,2, Kristina W Lai1, Nitya Bakshi1,2, Joanna K Grossman1,2, Preeti Jaggi2, Alexander Mallis1, Yun F Wang3,4, Robert C Jerris5,3, Peter A Lane1,2, Inci Yildirim2,6,7. 1. Aflac Cancer and Blood Disorders Center. 2. Departments of Pediatrics. 3. Pathology and Laboratory Medicine, School of Medicine. 4. Department of Pathology and Laboratory Medicine, Grady Health System, Atlanta, Georgia. 5. Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia. 6. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 7. Center for Childhood Infections and Vaccines, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia.
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.
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.
Authors: Deborah Woods; Robert J Hayashi; Michael M Binkley; Gianna W Sparks; Monica L Hulbert Journal: Pediatr Blood Cancer Date: 2017-05-19 Impact factor: 3.167
Authors: Michael D Warren; Patrick G Arbogast; Judy A Dudley; Lisa Kaltenbach; Wayne A Ray; Winfred C Wang; William O Cooper Journal: Arch Pediatr Adolesc Med Date: 2010-03
Authors: Marianne E Yee; Nitya Bakshi; Sara H Graciaa; Peter A Lane; Robert C Jerris; Yun F Wang; Inci Yildirim Journal: Pediatr Blood Cancer Date: 2019-02-05 Impact factor: 3.167
Authors: Thomas N Williams; Sophie Uyoga; Alex Macharia; Carolyne Ndila; Charlotte F McAuley; Daniel H Opi; Salim Mwarumba; Julie Makani; Albert Komba; Moses N Ndiritu; Shahnaaz K Sharif; Kevin Marsh; James A Berkley; J Anthony G Scott Journal: Lancet Date: 2009-09-09 Impact factor: 79.321