Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
PhD Program in Medicine, Universidad Complutense, Madrid, Spain.
Pediatr Blood Cancer. 2019 Jun;66(6):e27667. doi: 10.1002/pbc.27667. Epub 2019 Feb 10.
The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination.
To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low-risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS).
This 11-year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case-control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out.
A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low-risk factors for CSBI, whereas normal oxygen saturation and C-reactive protein <3 mg/dl were low-risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively.
In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low-risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.
近年来，由于青霉素预防和疫苗接种，镰状细胞病（SCD）患儿的细菌感染率有所下降。
确定 SCD 患儿中严重细菌感染（SBI）的发生率，并描述确诊 SBI（CSBI）和急性胸部综合征（ACS）的低危因素。
这是一项为期 11 年的回顾性队列研究，纳入了因发热性 SCD 入住西班牙一家参考医院的患儿。通过病例对照研究，将 SBI 患儿与无 SBI 患儿进行比较，并对 CSBI 和 ACS 组进行亚组分析。
共分析了 316 例发热性发作，其中 69 例（21.8%）有确诊或疑似 SBI。其中 13 例为 CSBI（4.1%），8 例为尿路感染，5 例为菌血症/败血症。在疑似 SBI 病例中，大多数为 ACS（54/56；96.4%）。年龄＞3 岁、无中心静脉导管、血流动力学稳定、降钙素原＜0.6ng/ml 是 CSBI 的低危因素，而血氧饱和度正常和 C 反应蛋白＜3mg/dl 是 ACS 的低危因素，其阴性预测值（NPV）分别为 98.3%、97.4%、96%、97.2%、87.5%和 85.8%。
在本队列中，SCD 患儿疫苗接种良好，预防措施充分，我们发现菌血症和 CSBI 的发生率较低。我们描述了 CSBI 和 ACS 的几个低危因素，均具有较高的 NPV。这些发现可能有助于制定风险评分，以便安全选择可以采用更保守治疗方法的患者。
