Invasive Bacterial Infections in Children With Sickle Cell Disease: 2014–2019
Jean Gaschignard, Bérengère Koehl, David C. Rees, Elena María Rincón‐López, Anna Vanderfaeillie, Alice Pascault, Slimane Allali, Elena Cela, Marie‐Hélène Odièvre, Isabelle Hau, Sandra Marisa Oliveira, Cécile Guillaumat, Valentine Brousse, Mariane de Montalembert, María Luisa Navarro Gómez, Naima Beldjoudi, Eduardo J. Bardón-Cancho, Cristina Epalza, BACT-SPRING study group, Malika Benkerrou, Jean Gaschignard, Bérengère Koehl, Alice Pascault, Valentine Brousse, Slimane Allali, M. de Montalembert, Marie‐Hélène Odièvre, Isabelle Hau, Cécile Guillaumat, Sophie Blais, C. Runel-Belliard, B. Pellegrino, Aurore Malric, Corinne Guitton, François Gouraud, Marie Petras, Philippe Bensaïd, Romain Basmaci, Stéphanie Eyssette-Guereau, Luu‐Ly Pham, Eduardo J. Bardón-Cancho, Elena Cela, María Luisa Navarro Gómez, Elena María Rincón‐López, Anna Ruiz‐Llobet, R. Adán, Pablo Velasco, Valle Recasens, Cristina Epalza, Vanesa Pérez‐Alonso, Montserrat Torrent, Amanda Bermejo, Angeles Vázquez, Raquel Portugal Rodríguez, Huda Alfaridi, Rana Almaghrabi, Marie Hoyoux, Anna Vanderfaeillie, Marisa Oliveira, Teresa Ferreira, David C. Rees
Abstract
BACKGROUND: Children with sickle cell disease (SCD) are at a high risk of invasive bacterial infections (IBI). Universal penicillin prophylaxis and vaccination, especially against Streptococcus pneumoniae, have deeply changed its epidemiology. Analysis of IBI in children with SCD in a post-13-valent pneumococcal vaccine era is limited. METHODS: Twenty-eight pediatric hospitals from 5 European countries retrospectively collected IBI episodes in SCD children aged 1 month to 18 years between 2014 and 2019. IBI was defined as a positive bacterial culture or polymerase chain reaction from a normally sterile fluid: blood, cerebrospinal, joint, or pleural fluid and deep surgical specimen. RESULTS: We recorded 169 IBI episodes. Salmonella spp. was the main isolated bacteria (n = 44, 26%), followed by Streptococcus pneumonia (Sp; n = 31, 18%) and Staphylococcus aureus (n = 20, 12%). Salmonella prevailed in osteoarticular infections and in primary bacteremia (45% and 23% of episodes, respectively) and Sp in meningitis and acute chest syndrome (88% and 50%, respectively). All Sp IBI occurred in children ≤10 years old, including 35% in children 5 to 10 years old. Twenty-seven (17%) children had complications of infection and 3 died: 2 because of Sp, and 1 because of Salmonella. The main risk factors for a severe IBI were a previous IBI and pneumococcal infection (17 Sp/51 cases). CONCLUSIONS: In a post-13-valent pneumococcal vaccine era, Salmonella was the leading cause of bacteremia in IBI in children with SCD in Europe. Sp came second, was isolated in children ≤10 years old, and was more likely to cause severe and fatal cases.