Features, Spectrum and Outcome of Proven Infections in Pediatric Sickle Cell Disease Patients in a Tertiary Hospital, Oman

AlHarthy F1 , AlSawafi A1 , AlHashami H2 , AlWaili B2
It has been observed that sickle cell disease (SCD) patients with documented infections have prolonged duration of fever and hospitalization. Our aim is to study the spectrum and outcome of infections in children with SCD.Methods:A retrospective chart review of all Omani children with SCD, who admitted with fever and proven infection over a 10 years’ period between January 2006 and July 2015, at the Royal Hospital, Sultanate of Oman.Results:Out of 61 admission episodes analyzed, 14 episodes were due to Bacteremia, 14 due to Pneumonia, 12 due to urinary tract infections (UTI), 11 due to Upper Respiratory Tract Infections (URTI) and 3 episodes were with osteomyelitis. Salmonella species was the most common cause of Bacteremia (8 episodes) whereas Influenza viruses were the most common cause of pneumonia and URTI. We found that 87% of identified organisms were sensitive to 3rd generation cephalosporins. Despite being on appropriate antibiotics coverage, most common organisms associated with prolonged fever was salmonella species that caused osteomyelitis and streptococcus pneumonia that caused pneumonia. Median hospital stay of 7 days was observed among all infective episodes in children with SCD who were admitted to the hematology ward. Osteomyelitis and bacteremia were the most common reason of prolonged hospital stay beyond 7 days.Conclusion:Salmonella species remain the most common cause of Bacteremia in children with SCD and most of the isolated organisms were sensitive to 3rd generation cephalosporin. Prolonged fever in patients with SCD is not uncommon despite appropriate antibiotic coverage. The results of our study shows that in a febrile but otherwise well looking child with SCD and documented infection with known organisms and antibiotics sensitivity should be observed clinically without extensive laboratory or radiological investigations.