Alzomor Omar, Aljobair Fahad, Al Kasim Fawaz, Azmet Fauzia, Alorini Sultan, Alshihayb Yazeed, Bahamdan Yazeed
Pediatric Infectious Diseases Department, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia.
Pediatric Hemato-Oncology Department, Children's Hospital, King Saud Medical City, Riyadh, Saudi Arabia.
Int J Pediatr Adolesc Med. 2022 Sep;9(3):165-170. doi: 10.1016/j.ijpam.2022.05.002. Epub 2022 May 31.
Sickle cell disease (SCD) is a wide prevalence disease worldwide. It has a spectrum of clinical manifestations. However, SCD patients are more susceptible to have a serious bacterial infection (SBI) as compared to other individuals.
The main objective of this study was to investigate the prevalence rate of serious bacterial infection (SBI) in febrile children with sickle cell disease (SCD), whose vaccinations are up to date and are on regular penicillin prophylaxis, presented to the emergency department (ED) to assist in the management approach of such patients.
A retrospective study included febrile SCD children under 12 years of age between 2014 and 2019 at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Patients were stratified according to the true culture result of each febrile event. Descriptive statistics were used to report data from the patient's medical records.
From 833 febrile events, 40 events were assessed for eligibility with positive culture results. Of these, 10 were excluded due to contamination. The rest, 30 children with confirmed SBI (3.6%, 30/833) (95% CI = 2.4%-5.1%) were recruited. The highest prevalence rate of SBI was for urinary tract infection (UTI) (2.2%, 19/833) (95% CI = 1.4%-3.5%), followed by bacteremia (1.3%, 11/833) (95% CI = 0.7-2.4), osteomyelitis (0.24%, 2/833) (95% CI = 0.03-0.86) and meningitis (0.12%, 1/833) (95% CI = 0.00-0.67). Pneumococcal was the most common isolate among children with bacteremia (46%, 5/11) followed by species (36%, 4/11). All the children fully recovered.
As the prevalence of SBI, particularly bacteremia, continues to decline with a favorable outcome in our population, ambulatory management practices for well-presented febrile SCD children should be encouraged, for there are no further reasons for admission and the patient can return soon to their hospital if his condition worsens or there is growth in the blood culture. Further effort is needed to determine whether blood culture and empiric antibiotics are necessary for each febrile event in the probable highly active vaccination era.
镰状细胞病（SCD）在全球广泛流行。它有一系列临床表现。然而，与其他个体相比，SCD患者更容易发生严重细菌感染（SBI）。
本研究的主要目的是调查患有镰状细胞病（SCD）且疫苗接种及时并定期接受青霉素预防性治疗的发热儿童中严重细菌感染（SBI）的患病率，这些儿童前往急诊科就诊，以协助对此类患者的管理。
一项回顾性研究纳入了2014年至2019年间沙特阿拉伯利雅得国王沙特医疗城（KSMC）12岁以下的发热SCD儿童。根据每次发热事件的实际培养结果对患者进行分层。使用描述性统计报告患者病历中的数据。
在833次发热事件中，40次事件因培养结果为阳性而被评估是否符合条件。其中，10次因污染被排除。其余30例确诊为SBI的儿童（3.6%，30/833）（95%置信区间=2.4%-5.1%）被纳入研究。SBI患病率最高的是尿路感染（UTI）（2.2%，19/833）（95%置信区间=1.4%-3.5%），其次是菌血症（1.3%，11/833）（95%置信区间=0.7-2.4）、骨髓炎（0.24%，2/833）（95%置信区间=0.03-0.86）和脑膜炎（0.12%，1/833）（95%置信区间=0.00-0.67）。肺炎球菌是菌血症儿童中最常见的分离株（46%，5/11），其次是其他菌种（36%，4/11）。所有儿童均完全康复。
由于SBI的患病率，尤其是菌血症的患病率在我们的人群中持续下降且预后良好，对于病情良好的发热SCD儿童，应鼓励采用门诊管理方法，因为没有进一步的入院理由，并且如果患者病情恶化或血培养有细菌生长，患者可以很快返回医院。在可能的高活性疫苗接种时代，需要进一步努力确定每次发热事件是否需要进行血培养和经验性使用抗生素。
