Risk-score based strategy to minimize antibiotic exposure in children with sickle cell disease and fever
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2021
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Springer
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Rincón-López, E. M., Navarro Gómez, M. L., Hernández-Sampelayo Matos, T., Aguilera-Alonso, D., Dueñas Moreno, E., Bellón Cano, J. M., Saavedra-Lozano, J., del Mar Santos Sebastián, M., García Morín, M., Beléndez Bieler, C., Lorente Romero, J., Cela de Julián, E., Santiago García, B., Hernanz Lobo, A., Bardón Cancho, E., Garrido Colino, C., Huerta Aragonés, J., Mata Fernández, C., Míguez Navarro, C., et al. (2022). Risk-score based strategy to minimize antibiotic exposure in children with sickle cell disease and fever. Infection, 50(2), 499-505. https://doi.org/10.1007/S15010-021-01702-W
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.