Department of Pediatrics, Pediatric Infectious Diseases Unit, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Infection. 2022 Apr;50(2):499-505. doi: 10.1007/s15010-021-01702-w. Epub 2021 Oct 1.
Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7-7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83-0.96) for the prediction of confirmed SBI and 0.86 (0.77-0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score-based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.
在过去几十年中，患有镰状细胞病 (SCD) 的儿童严重细菌感染 (SBI) 的发生频率有所降低。然而，由于存在 SBI 的潜在风险，他们在发热时通常会接受广谱抗生素的经验性治疗，在许多情况下还会住院。我们进行了一项前瞻性研究，纳入了 79 例发热的 SCD 患者（中位年龄 4.1 [1.7-7.5] 岁，男性占 78.5%；17 个病例被诊断为 SBI，其中 4 个被确诊），并开发了一种用于预测 SBI 的风险评分。最佳评分包括 CRP > 3 mg/dl、IL-6 > 125 pg/ml 和低氧血症，用于预测确诊 SBI 的 AUC 为 0.91（0.83-0.96），用于预测可能 SBI 的 AUC 为 0.86（0.77-0.93）。我们将患者分为 SBI 低、中、高风险 3 组。基于我们的风险评分的管理建议可以帮助安全地减少 SBI 低风险儿童的抗生素治疗和住院。
