BREAKING research suggests that bacteraemia is uncommon among children and young adults with sickle cell disease (SCD). According to the authors, SCD is the most common genetic disease, with an estimated 400,000 children born with it annually. Bacteraemia is significantly associated with morbidity and mortality in children and young adults with SCD; however, risk factors associated with outcomes and the absolute risk of bacteraemia are poorly defined.
The research team, led by Stephen Rineer, Cincinnati Children’s Hospital Medical Center, Ohio, USA, sought to define the risks and outcomes associated with the receipt of a bacteraemia diagnostic code in children and young adults with SCD who presented to the emergency department with fever.
The study utilised the Pediatric Health Information Systems (PHIS) database, enabling the analysis of 35,548 emergency department encounters from 11,181 patients at 26 paediatric hospitals across the USA. All patients were below the age of 22 years, and all encounters were between 1st January 2016–31st December 2021. The risk of bacteraemia was identified through diagnostic coding, while univariate analyses and multivariable regression were used to examine patient-level factors and bacteraemia.
Of the total emergency department encounters, 405 (1.1%) involved a diagnosis of bacteraemia within 3 days. Further analysis suggested that a prior history of bacteraemia (odds ratio [OR]: 1.36; 95% confidence interval [CI]: 1.01–1.83), central line-associated bloodstream infection (OR: 6.39; 95% CI: 3.02–13.52), or apheresis (OR: 1.77; 95% CI: 1.22–2.55) was associated with a diagnosis of bacteraemia.
The authors commented: “To our knowledge, this is one of the largest studies to date describing the risk of bacteraemia in this population,” adding that “prospective studies on children and young adults with [SCD] presenting with fever are needed to develop decision models and risk stratification tools to refine our approach and avoid unnecessary antibiotic exposure and hospitalisation in this population.”
