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Pattern of bacteraemia in febrile children with sickle cell anaemia

H O Okuonghae1, M U Nwankwo, E C Offor

  • 1Department of Child Health, University of Benin Teaching Hospital, Nigeria.

Annals of Tropical Paediatrics
|January 1, 1993
PubMed

Insights

Children with sickle cell anaemia (SCA) have higher rates of bacteraemia, predominantly from Gram-negative bacteria like Salmonella and Klebsiella. Early antibiotic use in SCA patients complicates diagnosis but identified sensitivities to gentamicin and cephalosporins.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Hematology

Background:

  • Sickle cell anaemia (SCA) is a genetic blood disorder associated with increased susceptibility to infections.
  • Fever in children with SCA often indicates serious bacterial infections, necessitating prompt diagnosis and treatment.
  • Bacteraemia, the presence of bacteria in the bloodstream, is a critical concern in children with SCA.

Purpose of the Study:

  • To investigate the prevalence and causative organisms of bacteraemia in febrile children with SCA compared to non-sickle cell controls.
  • To identify common bacterial pathogens and their antimicrobial susceptibility patterns in children with SCA.
  • To assess the impact of prior antibiotic use on bacteraemia detection in SCA patients.

Main Methods:

  • A prospective study comparing 162 children with SCA and 162 age-matched controls presenting with fever (rectal temperature >= 38.3°C).
  • Blood cultures were performed to detect bacteraemia.
  • Organisms isolated were identified, and their antibiotic susceptibility was tested.
  • Urine samples were analyzed for antimicrobial agents to detect occult antibiotic use.

Main Results:

  • Bacteraemia occurred in 32.5% of SCA patients versus 26% of controls.
  • Gram-negative bacteria, primarily Salmonella and Klebsiella, predominated in SCA patients (70.4%).
  • Staphylococcus aureus was the most common organism in controls (41%).
  • Bacteraemia incidence decreased after age 10 in both groups.
  • Prior antibiotic use was higher in SCA patients (47.6%) and sometimes detected despite parental denial.

Conclusions:

  • Febrile children with SCA have a higher risk of bacteraemia, with Gram-negative organisms being the most frequent cause.
  • Salmonella and Klebsiella are significant pathogens in this population.
  • The effectiveness of gentamicin and 3rd-generation cephalosporins against isolated organisms suggests their utility in empirical treatment.
  • Increased vigilance for bacteraemia and judicious antibiotic use are crucial in managing febrile children with SCA.

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