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Predictors of Bacteremia Among Children With Sickle Cell Disease Presenting With Fever

Savlov, Deena MD, FRCPC; Beck, Carolyn E. MD, MSc, FRCPC; DeGroot, Julie MSc; Odame, Isaac MD; Friedman, Jeremy N. MBChB, FRCPC

Journal of Pediatric Hematology/Oncology: July 2014 - Volume 36 - Issue 5 - p 384–388
doi: 10.1097/MPH.0000000000000070
Original Articles

Introduction: Bacterial sepsis is more common and potentially life threatening in children with sickle cell disease (SCD). Identification of variables that predict bacteremia may aid clinicians in recognizing patients with SCD at higher risk for sepsis.

Objective: To determine whether absolute neutrophil count (ANC) >20×109/L is an independent risk factor for bacteremia in children with SCD and to identify other predictors of bacteremia in this population.

Methods: A case-control study was conducted. Subjects were 0 to 18 years of age admitted to a tertiary care pediatric hospital over a 17-year period with SCD and fever at presentation. Cases had bacteremia, whereas controls had negative blood cultures.

Results: Data were analyzed for 40 cases and 120 controls. ANC>20×109/L was significantly more prevalent among cases (odds ratio [OR], 7.0; 95% confidence interval [CI], 2.6-18.9). Cases were more likely to have emesis (OR, 2.9; 95% CI, 1.0-8.4) and a higher proportion of band cells (OR, 1.3; 95% CI, 1.1-1.4) at presentation.

Conclusions: In a febrile child with SCD, an ANC>20×109/L, a higher proportion of band cells, and the presence of vomiting were associated with an increased likelihood of bacteremia.

*Department of Paediatrics, Division of Paediatric Medicine

Department of Paediatrics, Division of Hematology/Oncology, The Hospital for Sick Children

Faculty of Medicine, University of Toronto, Toronto, ON, Canada

The authors declare no conflict of interest.

Reprints: Deena Savlov, MD, FRCPC, Department of Paediatrics, Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8 (e-mail: deena.savlov@sickkids.ca).

Received June 5, 2013

Accepted October 16, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.