Low-risk factors for severe bacterial infection and acute chest syndrome in children with sickle cell disease.

Autor: Rincón-López EM; Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.; PhD Program in Medicine, Universidad Complutense, Madrid, Spain., Navarro Gómez ML; Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Hernández-Sampelayo Matos T; Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Saavedra-Lozano J; Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Aguilar de la Red Y; Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Hernández Rupérez B; Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain., Cela de Julián E; Pediatric Hematology and Oncology Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Jazyk: angličtina
Zdroj: Pediatric blood & cancer [Pediatr Blood Cancer] 2019 Jun; Vol. 66 (6), pp. e27667. Date of Electronic Publication: 2019 Feb 10.
DOI: 10.1002/pbc.27667
Abstrakt: Introduction: The rate of bacterial infections in children with sickle cell disease (SCD) has decreased in recent years, mainly due to penicillin prophylaxis and vaccination.
Objectives: To determine the rate of severe bacterial infection (SBI) in a cohort of children with SCD and to describe low-risk factors for confirmed SBI (CSBI) and acute chest syndrome (ACS).
Methods: This 11-year retrospective cohort study included children with febrile SCD admitted to a reference hospital in Spain. A case-control study was performed comparing patients diagnosed with SBI to those without SBI, and subanalyses for groups with CSBI and ACS were carried out.
Results: A total of 316 febrile episodes were analyzed; 69 (21.8%) had confirmed or possible SBI. Thirteen of those had CSBI (4.1%), eight urinary tract infection, and five bacteremia/sepsis. Among the cases of possible SBI, the majority had ACS (54/56; 96.4%). Age >3 years, absence of central venous catheter, hemodynamic stability, and procalcitonin <0.6 ng/ml were low-risk factors for CSBI, whereas normal oxygen saturation and C-reactive protein <3 mg/dl were low-risk factors for ACS, with negative predictive values (NPV) of 98.3%, 97.4%, 96%, 97.2%, 87.5%, and 85.8%, respectively.
Conclusion: In this cohort of children with SCD who were well vaccinated and received adequate prophylaxis, we found a low rate of bacteremia and CSBI. We described several low-risk factors for CSBI and ACS, all of them with a high NPV. These findings may help to develop a risk score to safely select the patients that could be managed with a more conservative approach.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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