Background: Streptococcal pneumoniae bacteremia is a significant cause of morbidity and mortality in Sickle Cell Disease (SCD) patients. Pneumococcal vaccination has decreased the bacteremia rate in both the general pediatric and SCD populations. Despite this decrease, and an increasing concern for antibiotic resistance, it remains standard practice to obtain blood cultures and administer antibiotics in all febrile (>38.5 0 °C) SCD patients. We conducted a systematic review and meta-analysis of the available studies of the prevalence of bacteremia in febrile SCD patients.
Methods: We searched the medical literature up to November 2018 in PUBMED, EMBASE and Web of Science using the search terms “epidemiology, prevalence, bacteremia, sickle cell anemia.” We only included studies with patients after 2000, when the pneumococcal 7-valent conjugate vaccine became widely available. Data were reported as means with 95% confidence intervals (95%, CI). We calculated the prevalence of bacteremia (95% CI) by dividing the number of positive blood cultures by the number of febrile episodes. The I2 statistic measured heterogeneity between prevalence estimates. Bias in our studies was quantified by the Newcastle-Ottawa quality assessment scale.
Results: Our search identified 228 citations with 9 studies meeting our inclusion/exclusion criteria encompassing 1,680 patients with 3,974 febrile episodes. The weighted prevalence of bacteremia across all studies was 1.76% (95% CI, 1.06%-2.67%) which showed moderate heterogeneity (Cochrane Q=19.7, p=0.01, I2 =58%). For S. pneumoniae the weighted prevalence with very low heterogeneity (Cochrane Q=3.57, p=0.83, I 2 =0%) was 0.26% (95% CI, 0.14%-0.48%). Risks for bacteremia except central lines could not be determined because of the low prevalence of the outcome.
Conclusion: Obtaining blood cultures on all febrile SCD children should be reconsidered in the face of the low prevalence of bacteremia, unless an obvious source is identified or if a central line is present.