A RETROSPECTIVE REVIEW OF BACTEREMIA AND OSTEOMYELITIS IN SICKLE CELL PATIENTS PRESENTING WITH FEVER IN LEBANON
(Abstract release date: 05/19/16)
EHA Library. Khalife S. 06/09/16; 132957; E1408
Dr. Sara Khalife
Contributions
Contributions
Abstract
Abstract: E1408
Type: Eposter Presentation
Background
Patients with sickle cell disease have higher risk of infections with encapsulated bacteria due to immature immune response and functional asplenia manifested by impaired complement activity. This has led historically to serious bacterial infections which include bacteremia with Streptococcal pneumonia and osteomyelitis mainly caused by Salmonella species.
Aims
In this study we aim to review the bacteremia rates in sickle cell patients in the era of vaccination against Streptococcus pneumonia and osteomyelitis rates with the causative organisms. The purpose is to prove an emergence of gram negative organisms, other than Salmonella, as the cause of osteomyelitis; and the vast decrease in Streptococcal pneumonia bacteremia rates after vaccination.
Methods
We conducted a retrospective chart review of 158 sickle cell patients registered at our database. Every patient presenting to ER with fever had his chart reviewed for blood cultures, pus cultures and MRI results for osteomyelitis over a period of 13 years. 16s ribosomal DNA was also performed to detect organisms not recovered by regular cultures.
Results
Sickle cell patients reviewed included 117 patients with SS type (74%), 36 patients with SB thalassemia type (23%), 2 patients with SC type (1%), 2 patients with SD type (1%), 1 patients with SO Arab type (1%). Patient ages ranged between 3 years and 40 years, with mean of 16 and median of 15. In the time period of the study, 105 patients (66%) presented to ER with fever leading to 581 febrile episodes. 341 episodes were in males (59%) and 240 in females (41%); 384 patients had SS type (66%), 171 had SB thalassemia type (29%), 26 had SD(5%). A total of 912 blood cultures were obtained. None of those grew Streptococcus pneumonia (0%), 14 cultures grew Staphlococci coagulase negative (1.5%), 1 culture grew Salmonella paratyphi B, and 3 cultures grew Salmonella group C (in same patient).There was a total of 9 episodes of osteomyelitis documented by imaging among patients who presented with fever (1.5%). 4 of the patients were females (44%), 5 were males (56%), 7 patients had sickle type SS (78%) and 2 had SB thalassemia type (22%). Ages ranged from 6 years to 28 years, with mean of 14 years. 4 patients (44%) had positive cultures and 5 patients (56%) had negative cultures. Cultures (puss/tissue) obtained included 1 with Enterobacter cloacae, 1 with Bacteroides, 1 with Pseudomonas aeruginosa (by 16s rDNA) and the fourth was a blood culture growing Salmonella group C. 16s rDNA was performed on tissue samples of 4 patients with osteomyelitis. Two of those patients had negative 16s rDNA and cultures. The remaining patients had Bacteroides detected by both modalities in one patient, and Pseudomonas aeruginosa detected only by 16s rDNA, not by culture, in the other. Osteomyelitis occurred in the spine in 3 patients (33%), in lower extremities in 3 patients (33%) and in upper extremity in 3 patients(33%). All our patients received pneumococcal vaccination, 104 patients (63% ) were on hydroxyurea, and 86 patients (47%) were on oral penicillin prophylaxis.
Conclusion
Immunization against Streptococcus pneumonia has virtually eliminated pneumococcal bacteremia as was evident in our patient population. However, there was emergence of gram negative organisms, other than Salmonella as the cause of osteomyelitis. This has important implications for the empiric antibiotic coverage in sickle cell patients with osteomyelitis. Molecular testing by 16s rDNA is to be considered to detect causative organisms of osteomyelitis on tissue/ pus cultures when cultures fail to grow any.
Session topic: E-poster
Keyword(s): Fever, Sickle cell anemia
Type: Eposter Presentation
Background
Patients with sickle cell disease have higher risk of infections with encapsulated bacteria due to immature immune response and functional asplenia manifested by impaired complement activity. This has led historically to serious bacterial infections which include bacteremia with Streptococcal pneumonia and osteomyelitis mainly caused by Salmonella species.
Aims
In this study we aim to review the bacteremia rates in sickle cell patients in the era of vaccination against Streptococcus pneumonia and osteomyelitis rates with the causative organisms. The purpose is to prove an emergence of gram negative organisms, other than Salmonella, as the cause of osteomyelitis; and the vast decrease in Streptococcal pneumonia bacteremia rates after vaccination.
Methods
We conducted a retrospective chart review of 158 sickle cell patients registered at our database. Every patient presenting to ER with fever had his chart reviewed for blood cultures, pus cultures and MRI results for osteomyelitis over a period of 13 years. 16s ribosomal DNA was also performed to detect organisms not recovered by regular cultures.
Results
Sickle cell patients reviewed included 117 patients with SS type (74%), 36 patients with SB thalassemia type (23%), 2 patients with SC type (1%), 2 patients with SD type (1%), 1 patients with SO Arab type (1%). Patient ages ranged between 3 years and 40 years, with mean of 16 and median of 15. In the time period of the study, 105 patients (66%) presented to ER with fever leading to 581 febrile episodes. 341 episodes were in males (59%) and 240 in females (41%); 384 patients had SS type (66%), 171 had SB thalassemia type (29%), 26 had SD(5%). A total of 912 blood cultures were obtained. None of those grew Streptococcus pneumonia (0%), 14 cultures grew Staphlococci coagulase negative (1.5%), 1 culture grew Salmonella paratyphi B, and 3 cultures grew Salmonella group C (in same patient).There was a total of 9 episodes of osteomyelitis documented by imaging among patients who presented with fever (1.5%). 4 of the patients were females (44%), 5 were males (56%), 7 patients had sickle type SS (78%) and 2 had SB thalassemia type (22%). Ages ranged from 6 years to 28 years, with mean of 14 years. 4 patients (44%) had positive cultures and 5 patients (56%) had negative cultures. Cultures (puss/tissue) obtained included 1 with Enterobacter cloacae, 1 with Bacteroides, 1 with Pseudomonas aeruginosa (by 16s rDNA) and the fourth was a blood culture growing Salmonella group C. 16s rDNA was performed on tissue samples of 4 patients with osteomyelitis. Two of those patients had negative 16s rDNA and cultures. The remaining patients had Bacteroides detected by both modalities in one patient, and Pseudomonas aeruginosa detected only by 16s rDNA, not by culture, in the other. Osteomyelitis occurred in the spine in 3 patients (33%), in lower extremities in 3 patients (33%) and in upper extremity in 3 patients(33%). All our patients received pneumococcal vaccination, 104 patients (63% ) were on hydroxyurea, and 86 patients (47%) were on oral penicillin prophylaxis.
Conclusion
Immunization against Streptococcus pneumonia has virtually eliminated pneumococcal bacteremia as was evident in our patient population. However, there was emergence of gram negative organisms, other than Salmonella as the cause of osteomyelitis. This has important implications for the empiric antibiotic coverage in sickle cell patients with osteomyelitis. Molecular testing by 16s rDNA is to be considered to detect causative organisms of osteomyelitis on tissue/ pus cultures when cultures fail to grow any.
Session topic: E-poster
Keyword(s): Fever, Sickle cell anemia
Abstract: E1408
Type: Eposter Presentation
Background
Patients with sickle cell disease have higher risk of infections with encapsulated bacteria due to immature immune response and functional asplenia manifested by impaired complement activity. This has led historically to serious bacterial infections which include bacteremia with Streptococcal pneumonia and osteomyelitis mainly caused by Salmonella species.
Aims
In this study we aim to review the bacteremia rates in sickle cell patients in the era of vaccination against Streptococcus pneumonia and osteomyelitis rates with the causative organisms. The purpose is to prove an emergence of gram negative organisms, other than Salmonella, as the cause of osteomyelitis; and the vast decrease in Streptococcal pneumonia bacteremia rates after vaccination.
Methods
We conducted a retrospective chart review of 158 sickle cell patients registered at our database. Every patient presenting to ER with fever had his chart reviewed for blood cultures, pus cultures and MRI results for osteomyelitis over a period of 13 years. 16s ribosomal DNA was also performed to detect organisms not recovered by regular cultures.
Results
Sickle cell patients reviewed included 117 patients with SS type (74%), 36 patients with SB thalassemia type (23%), 2 patients with SC type (1%), 2 patients with SD type (1%), 1 patients with SO Arab type (1%). Patient ages ranged between 3 years and 40 years, with mean of 16 and median of 15. In the time period of the study, 105 patients (66%) presented to ER with fever leading to 581 febrile episodes. 341 episodes were in males (59%) and 240 in females (41%); 384 patients had SS type (66%), 171 had SB thalassemia type (29%), 26 had SD(5%). A total of 912 blood cultures were obtained. None of those grew Streptococcus pneumonia (0%), 14 cultures grew Staphlococci coagulase negative (1.5%), 1 culture grew Salmonella paratyphi B, and 3 cultures grew Salmonella group C (in same patient).There was a total of 9 episodes of osteomyelitis documented by imaging among patients who presented with fever (1.5%). 4 of the patients were females (44%), 5 were males (56%), 7 patients had sickle type SS (78%) and 2 had SB thalassemia type (22%). Ages ranged from 6 years to 28 years, with mean of 14 years. 4 patients (44%) had positive cultures and 5 patients (56%) had negative cultures. Cultures (puss/tissue) obtained included 1 with Enterobacter cloacae, 1 with Bacteroides, 1 with Pseudomonas aeruginosa (by 16s rDNA) and the fourth was a blood culture growing Salmonella group C. 16s rDNA was performed on tissue samples of 4 patients with osteomyelitis. Two of those patients had negative 16s rDNA and cultures. The remaining patients had Bacteroides detected by both modalities in one patient, and Pseudomonas aeruginosa detected only by 16s rDNA, not by culture, in the other. Osteomyelitis occurred in the spine in 3 patients (33%), in lower extremities in 3 patients (33%) and in upper extremity in 3 patients(33%). All our patients received pneumococcal vaccination, 104 patients (63% ) were on hydroxyurea, and 86 patients (47%) were on oral penicillin prophylaxis.
Conclusion
Immunization against Streptococcus pneumonia has virtually eliminated pneumococcal bacteremia as was evident in our patient population. However, there was emergence of gram negative organisms, other than Salmonella as the cause of osteomyelitis. This has important implications for the empiric antibiotic coverage in sickle cell patients with osteomyelitis. Molecular testing by 16s rDNA is to be considered to detect causative organisms of osteomyelitis on tissue/ pus cultures when cultures fail to grow any.
Session topic: E-poster
Keyword(s): Fever, Sickle cell anemia
Type: Eposter Presentation
Background
Patients with sickle cell disease have higher risk of infections with encapsulated bacteria due to immature immune response and functional asplenia manifested by impaired complement activity. This has led historically to serious bacterial infections which include bacteremia with Streptococcal pneumonia and osteomyelitis mainly caused by Salmonella species.
Aims
In this study we aim to review the bacteremia rates in sickle cell patients in the era of vaccination against Streptococcus pneumonia and osteomyelitis rates with the causative organisms. The purpose is to prove an emergence of gram negative organisms, other than Salmonella, as the cause of osteomyelitis; and the vast decrease in Streptococcal pneumonia bacteremia rates after vaccination.
Methods
We conducted a retrospective chart review of 158 sickle cell patients registered at our database. Every patient presenting to ER with fever had his chart reviewed for blood cultures, pus cultures and MRI results for osteomyelitis over a period of 13 years. 16s ribosomal DNA was also performed to detect organisms not recovered by regular cultures.
Results
Sickle cell patients reviewed included 117 patients with SS type (74%), 36 patients with SB thalassemia type (23%), 2 patients with SC type (1%), 2 patients with SD type (1%), 1 patients with SO Arab type (1%). Patient ages ranged between 3 years and 40 years, with mean of 16 and median of 15. In the time period of the study, 105 patients (66%) presented to ER with fever leading to 581 febrile episodes. 341 episodes were in males (59%) and 240 in females (41%); 384 patients had SS type (66%), 171 had SB thalassemia type (29%), 26 had SD(5%). A total of 912 blood cultures were obtained. None of those grew Streptococcus pneumonia (0%), 14 cultures grew Staphlococci coagulase negative (1.5%), 1 culture grew Salmonella paratyphi B, and 3 cultures grew Salmonella group C (in same patient).There was a total of 9 episodes of osteomyelitis documented by imaging among patients who presented with fever (1.5%). 4 of the patients were females (44%), 5 were males (56%), 7 patients had sickle type SS (78%) and 2 had SB thalassemia type (22%). Ages ranged from 6 years to 28 years, with mean of 14 years. 4 patients (44%) had positive cultures and 5 patients (56%) had negative cultures. Cultures (puss/tissue) obtained included 1 with Enterobacter cloacae, 1 with Bacteroides, 1 with Pseudomonas aeruginosa (by 16s rDNA) and the fourth was a blood culture growing Salmonella group C. 16s rDNA was performed on tissue samples of 4 patients with osteomyelitis. Two of those patients had negative 16s rDNA and cultures. The remaining patients had Bacteroides detected by both modalities in one patient, and Pseudomonas aeruginosa detected only by 16s rDNA, not by culture, in the other. Osteomyelitis occurred in the spine in 3 patients (33%), in lower extremities in 3 patients (33%) and in upper extremity in 3 patients(33%). All our patients received pneumococcal vaccination, 104 patients (63% ) were on hydroxyurea, and 86 patients (47%) were on oral penicillin prophylaxis.
Conclusion
Immunization against Streptococcus pneumonia has virtually eliminated pneumococcal bacteremia as was evident in our patient population. However, there was emergence of gram negative organisms, other than Salmonella as the cause of osteomyelitis. This has important implications for the empiric antibiotic coverage in sickle cell patients with osteomyelitis. Molecular testing by 16s rDNA is to be considered to detect causative organisms of osteomyelitis on tissue/ pus cultures when cultures fail to grow any.
Session topic: E-poster
Keyword(s): Fever, Sickle cell anemia
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