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Emergence of gram‐negative organisms as the cause of infections in patients with sickle cell disease
Author(s) -
Khalife Sara,
HannaWakim Rima,
Ahmad Rasha,
Haidar Rachid,
Makhoul Peter G.,
Khoury Nabil,
Dbaibo Ghassan,
Abboud Miguel R.
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28784
Subject(s) - medicine , osteomyelitis , bacteremia , streptococcus pneumoniae , salmonella enterica , blood culture , disease , septic arthritis , salmonella , microbiology and biotechnology , immunology , antibiotics , arthritis , biology , bacteria , genetics
Abstract Background Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram‐negative organisms other than Salmonella as the cause of osteomyelitis and document a vast decrease in Streptococcus pneumoniae bacteremia rates. Methods We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis. Results The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew Streptococcus pneumoniae , 14 grew coagulase‐negative staphylococci (1.5%), one grew Salmonella enterica Paratyphi B, and three grew Salmonella enterica group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including Enterobacter cloacae , Bacteroides , Pseudomonas aeruginosa , and Salmonella enterica group C. Conclusions Immunization against Streptococcus pneumoniae and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram‐negative organisms other than Salmonella as the cause of osteomyelitis in patients with sickle cell disease.