Bacteremia Risk Low in Feverish Children and Young Adults with Sickle Cell Disease

Stephen Rineer, MD

Credit: Cincinnati Children's

A new investigation found the infectious bloodstream condition bacteremia was an unlikely diagnosis among children and young adults with sickle cell disease (SCD) who sought care in the emergency department (ED). However, investigators identified an increased likelihood of diagnosis if the patient had previous bacteremia infections or a history of central line placement.¹

Bacteremia poses a significant threat to the health of these individuals, as it can lead to morbidity and mortality in the SCD population. This study aimed to address the lack of understanding of the absolute risk, factors, and outcomes of the condition and provide insight into the prevalence, risk factors, and outcomes of bacteremia in this setting.

Specifically, the investigators led by Stephen Rineer, MD, of the Division of Emergency Medicine at Cincinnati Children’s Hospital Medical Center, evaluated patients with SCD presenting to the ED with fever by gathering data from the Pediatric Health Information Systems database.

Analyzing the Prevalence of Bacteremia in SCD

The multicenter retrospective cohort study included children and young adults < 22 years of age with SCD in EDs between January 2016 and December 2021 with a fever. The identification of bacteremia was based on diagnostic coding and the team of investigators used univariate and multivariable regression analyses to examine patient-level factors associated with the disease.

Results of the research were derived from 35,548 ED encounters, representing 11,181 individual patients from 36 hospitals. The median age of the cohort was 6.17 years, and approximately half the population was male (52.9%).

Investigators detected bacteremia in 405 cases or 1.1% of the encounters. The study found that a history of bacteremia–associated bloodstream infection, osteomyelitis, stroke, central line bloodstream infection (CLABSI), central venous catheter, or apheresis was associated with an increased likelihood of bacteremia.

Data from the multivariable analysis showed those with a history of bacteremia had 1.36 times higher odds of another case of bacteremia (95% CI: 1.01 - 1.83).

Additionally, CLABSI was associated with a significantly elevated risk (OR: 6.39; 95% CI: 3.02 - 13.52), as was apheresis (OR: 1.77; 95% CI: 1.22 - 2.55). It was noted that age, sex, hemoglobin sickle cell genotype, and race and ethnicity did not exhibit a significant association with bacteremia.

A novel episode of bacteremia is unlikely to occur in EDs for children and young adults in this population presenting with fever. However, the findings demonstrated patients with a history of invasive bacterial infection, CLABSI, or the presence of a central line were linked with an increased risk of bacteremia. Investigators further noted the age and SCD genotype did not indicate a significant correlation in these analyses.

While the incidence of bacteremia in SCD has decreased with the introduction of prophylactic measures, disease-modifying medications, and vaccine development, investigators acknowledged, it’s still higher than the risk of undetected bacteremia in febrile young children without SCD who present to the ED.

“To our knowledge, this is one of the largest studies to date describing the risk of bacteremia in this population,” the team wrote. “Our results are similar to small single-center studies from the past 10 years that have reported a wider range of bacteremia (0.3% - 4.2%, with a weighted average of 1.9%), limited by their smaller sample sizes.”

References:

1. Rineer S, Walsh PS, Smart LR, Harun N, Schnadower D, Lipshaw MJ. Risk of Bacteremia in Febrile Children and Young Adults With Sickle Cell Disease in a Multicenter Emergency Department Cohort. JAMA Netw Open. 2023;6(6):e2318904. doi:10.1001/jamanetworkopen.2023.18904