Risk-score based strategy to minimize antibiotic exposure in children with sickle cell disease and fever

Infection. 2022 Apr;50(2):499-505. doi: 10.1007/s15010-021-01702-w. Epub 2021 Oct 1.

Abstract

Severe bacterial infections (SBI) have become less frequent in children with sickle cell disease (SCD) in the last decades. However, because of their potential risk of SBI, they usually receive empirical therapy with broad-spectrum antibiotics when they develop fever and are hospitalized in many cases. We performed a prospective study including 79 SCD patients with fever [median age 4.1 (1.7-7.5) years, 78.5% males; 17 of the episodes were diagnosed with SBI and 4 of them were confirmed] and developed a risk score for the prediction of SBI. The optimal score included CRP > 3 mg/dl, IL-6 > 125 pg/ml and hypoxemia, with an AUC of 0.91 (0.83-0.96) for the prediction of confirmed SBI and 0.86 (0.77-0.93) for possible SBI. We classified the patients in 3 groups: low, intermediate and high risk of SBI. Our risk-score-based management proposal could help to safely minimize antibiotic treatments and hospital admissions in children with SCD at low risk of SBI.

Keywords: Acute chest syndrome; Antibiotics; Children; Infection; Risk score; Sickle cell disease.

MeSH terms

  • Anemia, Sickle Cell* / complications
  • Anemia, Sickle Cell* / drug therapy
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections* / diagnosis
  • Bacterial Infections* / drug therapy
  • Child
  • Child, Preschool
  • Female
  • Fever / drug therapy
  • Fever / etiology
  • Humans
  • Infant
  • Male
  • Prospective Studies
  • Risk Factors

Substances

  • Anti-Bacterial Agents