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Bacteremia risk low in febrile sickle cell disease patients
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Febrile children with sickle cell disease are experiencing bacteremia at low rates and have no associated morbidity or mortality when managed as outpatients, according to recent study results published in Pediatrics.
“A well-appearing febrile child with [sickle cell disease] may be managed as an outpatient after blood is obtained for bacterial culture and parenteral antibiotics are administered, provided there are no other reasons for admission and the patient is able to return promptly for worsening condition or for growth of a pathogen from their blood culture,” researchers wrote.
The retrospective cohort study included 1,118 febrile patients with sickle cell disease presented at Boston Children’s Hospital between 1993 and 2010.
Researchers found that only nine participants had growth presence of a pathogen in blood cultures (0.8%; 95% CI, 0.3-1.3).
“Of the nine episodes, none of the patients were ill appearing or required supportive care while in the ED nor did any morbidity or mortality occur,” researchers wrote.
They also found that of 466 participants managed as outpatients, 0.6% had bacteremia. All were treated with IV ceftriaxone at the first outpatient visit and returned when contacted that there was a bacterial growth in the blood culture. These participants were not ill-appearing upon return, did not require emergency care and were not admitted to the ICU.
“We believe that febrile [sickle cell disease] patients managed as outpatients should have follow-up in 24 hours to assess their clinical condition ... but that a second dose of antibiotics is not generally required because the vast majority of blood cultures grow within 24 hours,” researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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