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Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014-2019
Jean Gaschignard1,2, Bérengère Koehl3,4,5, David C Rees6
1Department of Pediatrics, Groupe Hospitalier Nord Essonne, Longjumeau, France.
Insights
In children with sickle cell disease (SCD), Salmonella is now the leading cause of invasive bacterial infections (IBI), surpassing Streptococcus pneumoniae. Pneumococcal infections remain a significant risk for severe outcomes in younger children.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Vaccinology
Background:
- Children with sickle cell disease (SCD) face a high risk of invasive bacterial infections (IBI).
- Penicillin prophylaxis and vaccination have altered IBI epidemiology in SCD.
- Data on IBI in SCD children post-13-valent pneumococcal vaccine is limited.
Purpose of the Study:
- To analyze the epidemiology of IBI in children with SCD in Europe.
- To identify causative pathogens and risk factors for severe infections.
- To assess IBI trends in the post-13-valent pneumococcal vaccine era.
Main Methods:
- Retrospective data collection of IBI episodes in SCD children (1 month-18 years) from 28 European pediatric hospitals (2014-2019).
- IBI defined by positive bacterial culture or PCR from sterile fluids.
- Analysis included pathogen identification, infection site, and patient outcomes.
Main Results:
- 169 IBI episodes were recorded. Salmonella spp. was the most common pathogen (26%), followed by Streptococcus pneumoniae (Sp) (18%).
- Salmonella was prevalent in osteoarticular infections and bacteremia; Sp predominated in meningitis and acute chest syndrome.
- All Sp IBI occurred in children ≤10 years old. 17% of children experienced complications, and 3 deaths occurred (2 from Sp, 1 from Salmonella).
Conclusions:
- Salmonella is the leading cause of bacteremia in pediatric SCD patients in Europe post-13-valent pneumococcal vaccine.
- Streptococcus pneumoniae remains a significant cause of severe and fatal IBI, particularly in children under 10.
- Surveillance of IBI pathogens in SCD children is crucial, especially considering evolving vaccine landscapes.
Background:
Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited.
Methods:
Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen.
Results:
We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases).
Conclusions:
In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.
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