Bacteremia in children with sickle hemoglobinopathies.

BACKGROUND: Bacteremia is one of the most feared infectious complications of sickle cell disease, and it is associated with a high mortality rate in children. The objective of our study was to investigate the proportion of bacteremia among febrile children with sickle hemoglobinopathies and the clinical factors associated with bacteremia.

METHODS: Clinical and microbiological data from children with sickle hemoglobinopathies being followed up at the Pediatric Hematology Clinic at the University of Rochester Medical Center in Rochester, New York, were retrospectively analyzed. The data were collected from medical records covering the time period of June 1997 to December 2006, which included the periods before and after the introduction of routine heptavalent pneumococcal conjugate vaccine usage. Proportions of positive blood cultures among febrile children, the types of organisms causing bacteremia, and clinical and sociodemographic factors were analyzed by χ and t tests as appropriate.

RESULTS: The overall proportion of positive blood cultures was 3.8%; 1% was considered to yield true pathogens. Pneumococcal bacteremia decreased from 0.7% in the pre-pneumococcal conjugate vaccine-7 era to 0.2% in the post-pneumococcal conjugate vaccine-7 era; however, the difference was not statistically significant. Pathogens other than pneumococcus were responsible for most bacteremic episodes. No clinical or social factors were found to have statistically significant associations with positive blood cultures.

CONCLUSIONS: Approximately 1% of children with sickle hemoglobinopathies with fever have bacteremia despite current penicillin prophylaxis and pneumococcal immunization, although most episodes are due to nonpneumococcal pathogens. Prompt evaluation of such febrile children with sickle hemoglobinopathies remains warranted.