In young patients with sickle cell disease (SCD) presenting to an emergency department (ED) with fever, bacteremia was found to be an uncommon diagnosis, but was associated with certain possible risk factors. This is according to the results of a study published in JAMA Network Open.
Age and genotype of SCD did not appear associated with a bacteremia diagnosis in the study population. However, factors such as a history of invasive bacterial infection and central line-associated bloodstream infection (CLABSI) were linked to having a bacteremia diagnosis in this study.
The study was a retrospective cohort analysis based on data obtained from the Pediatric Health Information Systems database, which includes information from approximately 50 US-based pediatric tertiary care hospitals.
Patients included in the analysis were younger than 22 years of age, had a diagnosis of SCD, and presented to any of the included hospitals with a fever or underwent testing and treatment that would be consistent with having a fever. Demographic characteristics and information related to diagnoses and outcomes were evaluated in the analysis. Diagnosis of bacteremia was the primary study outcome, based on the index ED encounter and any encounters within 3 days of ED discharge.
The study included 35,548 ED encounters for 11,181 patients overall who were seen across 36 hospitals during a 5-year study period. Patients had a median age of 6.17 years (interquartile range, 2.36-12.11).
There was a diagnosis of bacteremia within 3 days of the index ED visit in 405 of the encounters (1.1%; 95% CI, 1.03%-1.26%), and involving 371 of the patients. Age, sex, race and ethnicity, type of insurance, and SCD genotype were not associated with the presence or absence of a bacteremia diagnosis in this study.
A univariate analysis indicated that a history of bacteremia, osteomyelitis, stroke, CLABSI, central venous catheter placement, and apheresis were factors associated with receiving a bacteremia diagnosis in this study population.
A multivariable analysis revealed independent associations between some of these factors and receiving a bacteremia diagnosis in this population. These included CLABSI (odds ratio [OR], 6.39; 95% CI, 3.02-13.52; P <.001), apheresis (OR, 1.77; 95% CI, 1.22-2.55; P <.001), and a history of bacteremia (OR, 1.36; 95% CI, 1.01-1.83; P =.04).
“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 hospitalization in this population,” the study investigators wrote in their report.
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