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

• Type of Material: Article
• Authors: Marianne Yee, Emory University; Kristina W Lai, Aflac Cancer and Blood Disorders Center; Nitya Bakshi, Emory University; Joanna Grossman, Emory University; Preeti Jaggi, Emory University; Alexander Mallis, Aflac Cancer and Blood Disorders Center; Yun Wang, Emory University; Robert Jerris, Emory University; Peter Lane Jr, Emory University; Inci Yildirim, Emory University
• Language: English
• Date: 2022-04-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 by the American Academy of Pediatrics
• Final Published Version (URL): http://dx.doi.org/10.1542/peds.2021-051892
• Title of Journal or Parent Work: PEDIATRIC INFECTIOUS DISEASE JOURNAL
• Volume: 41
• Issue: 4
• Start Page: 323
• End Page: 323
• Grant/Funding Information: Supported by a grant from the Abraham J. & Phyllis Katz Foundation. Dr Yee received funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award 1K23HL146901-01A1. Dr Bakshi received funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award 1K23HL140142-02. Dr Yildirim received funding from Center for Childhood Infections and Vaccines at Emory University and Children’s Healthcare of Atlanta. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funded by the National Institutes of Health (NIH).
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; Immunology; Infectious Diseases

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.