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Fever in children with sickle cell disease: are all fevers equal?

BACKGROUND: Sepsis is the most common cause of mortality in sickle cell disease (SCD). Empiric antibiotic administration after obtaining blood cultures in febrile children with SCD has been a standard practice parameter.

OBJECTIVE: Our primary objective was to calculate the rate of bacteremia in febrile pediatric patients with SCD. Our secondary objective was to establish whether vital signs or diagnostics predict bacteremia in these patients.

METHODS: We conducted a retrospective chart review of patients with SCD who presented to an urban pediatric emergency department in Newark, NJ between January 1, 2001 and June 30, 2011 with the chief complaint of fever. Patients between the ages of 0 and 20 years with SCD who presented with the chief complaint of fever and who had a blood culture performed were included. Descriptive data, visit-specific data, and diagnostic data were collected.

RESULTS: Charts of 307 patients were included. Six patients had a positive blood culture, one of which was considered a true pathogen (Streptococcus pneumoniae) (0.33%; 95% confidence interval 0.06%-1.86%). There was no statistical significance between the means of visit-specific and diagnostic data of patients with positive blood cultures and those with negative blood cultures.

CONCLUSIONS: The incidence of bacteremia in febrile children with SCD presenting to the emergency department is low. Close follow-up within 24 hours and delayed antibiotic administration can be a plausible alternative treatment option in this population.

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