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Predictors for Bacteremia in Febrile Sickle Cell Disease Children in the Post-7-Valent Pneumococcal Conjugate Vaccine Era

Chang, Todd P. MD*; Kriengsoontorkij, Worapant MD; Chan, Linda S. PhD‡,§; Wang, Vincent J. MD, MHA*

Journal of Pediatric Hematology/Oncology: July 2013 - Volume 35 - Issue 5 - p 377–382
doi: 10.1097/MPH.0b013e31828ac9e2
Original Articles

Objectives: The objective of this study was to determine the incidence of bacteremia in febrile sickle cell disease (SCD) children before and after the 7-valent pneumococcal vaccine (PCV7), and to determine clinical factors associated with bacteremia following PCV7.

Patients and Methods: We reviewed all febrile events in SCD children from 1993 to 2009 at a tertiary care pediatric center, comparing general bacteremia and pneumococcal bacteremia incidence for 3 time periods around the PCV7. Univariate analysis and stepwise logistic regression identified clinical factors most associated with bacteremia in this population.

Results: Of 466 SCD children identified, there were 2504 febrile events. We found 84 cases of bacteremia; 8 were pneumococcal. The general bacteremia incidence decreased significantly from 5.60% to 2.44% (P<0.001) over time. Pneumococcal bacteremia incidence did not decrease (P=0.13). Following PCV7, we identified 4 significant independent risk factors associated with general bacteremia: the presence of a central venous line, higher absolute band count, toxic appearance, and older age.

Conclusions: In febrile SCD children, the incidence of general bacteremia decreased over time. No decrease in pneumococcal bacteremia was found. The presence of a central venous line, absolute band count, clinical appearance, and age may help predict bacteremia in this population.

*Division of Emergency Medicine and Transport, Children’s Hospital Los Angeles

Division of Biostatistics and Outcomes Assessment, Los Angeles County+University of Southern California Medical Center

§Department of Pediatrics, Division of Research on Children, Youth, and Families, Keck School of Medicine of USC, Los Angeles, CA

Department of Pediatrics, Siriraj Hospital/Mahidol University, Bangkok, Thailand

Prior Presentations: Pediatric Academic Societies Conference (Denver, CO), presented as a poster abstract May 3, 2011.

The authors declare no conflict of interest.

Reprints: Todd P. Chang, MD, Division of Emergency Medicine and Transport, Children’s Hospital Los Angeles, 4650 Sunset Blvd. #113, Los Angeles, CA 90027 (e-mail:

Received March 1, 2012

Accepted January 30, 2013

© 2013 by Lippincott Williams & Wilkins.