Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Pediatr Blood Cancer. 2021 Jan;68(1):e28784. doi: 10.1002/pbc.28784. Epub 2020 Oct 31.
Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis and document a vast decrease in Streptococcus pneumoniae bacteremia rates.
We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis.
The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew Streptococcus pneumoniae, 14 grew coagulase-negative staphylococci (1.5%), one grew Salmonella enterica Paratyphi B, and three grew Salmonella enterica group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including Enterobacter cloacae, Bacteroides, Pseudomonas aeruginosa, and Salmonella enterica group C.
Immunization against Streptococcus pneumoniae and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram-negative organisms other than Salmonella as the cause of osteomyelitis in patients with sickle cell disease.
由于不成熟的免疫反应和功能性无脾，镰状细胞病患者感染带荚膜细菌的风险更高。我们旨在研究我们的患者群体中是否有除沙门氏菌以外的革兰氏阴性菌引起骨髓炎，并记录肺炎链球菌菌血症率的大幅下降。
我们对我院登记的 158 例镰状细胞病患者进行了回顾性图表审查。在 13 年的时间里，每位因发热到急诊科就诊的患者都对其病历进行了血液培养、伤口培养和骨髓炎磁共振成像结果的回顾。
因发热到急诊科就诊的患者人数为 105 例，共出现 581 例发热性发作和 893 例血培养。其中，无培养物生长肺炎链球菌，14 株生长凝固酶阴性葡萄球菌（1.5%），一株生长伤寒沙门氏菌副伤寒 B 型，三株生长沙门氏菌 C 组（同一患者）。发热伴影像学确诊的镰状细胞病患者骨髓炎发作总数为 9 例（1.5%）。在骨髓炎患者中，有 4 例（44%）分离出了细菌，包括阴沟肠杆菌、拟杆菌、铜绿假单胞菌和沙门氏菌 C 组。
肺炎链球菌疫苗接种和预防性青霉素的使用几乎消除了我们患者中的肺炎链球菌菌血症。我们观察到除沙门氏菌以外的革兰氏阴性菌在镰状细胞病患者中引起骨髓炎。
