title: Bloodstream infection in adults with sickle cell disease: association with venous catheters, Staphylococcus aureus, and bone-joint infections.
abstract: Although well documented in children with sickle cell disease (SCD), the incidence, cause, and outcome of bloodstream infection (BSI) are poorly defined in adults with SCD. Through a 5-year retrospective analysis of a cohort of 900 patients followed at our institution, we identified 56 episodes of BSI in 47 patients. The incidence rate of BSI was 1.2 episodes per 100 patient-years. As compared to the patients followed in the cohort, those with BSI were more likely to be younger (p = 0.001), to have Hb-S disease (p = 0.008), severe disease (p = 0.001), or additional immunosuppression (p = 0.05). BSI was hospital-acquired in 46% of cases and mainly associated with venous catheters (41%) and Staphylococcus aureus (34%). Pneumococci were rarely identified (10.7%). Despite an adequate duration of antibiotic therapy, the course of BSI was marked by a high frequency of associated bone-joint infection. Bone-joint infection was noted in 18 patients (32% of episodes) and occurred either during the initial BSI episode (13 patients) or 1-6 months after BSI resolution (5 patients). Factors associated with the occurrence of bone-joint infection were previous osteonecrosis (relative risk, 2.5; 95% confidence interval, 1.2-5.3) and S. aureus infection (relative risk, 3.8; 95% confidence interval, 1.8-8.4). In conclusion, BSI is a rare event in adults with SCD compared to children. It mainly occurs in those with a severe underlying disease and a venous catheter. These patients have a high risk of associated bone-joint infection and therefore must be closely monitored.
authors.affiliation: From Service de Médecine Interne I (VZ, BG), Centre de la Drépanocytose (AH, DB, FG), Réanimation Médicale (J-RZ, CB-B), Département de Santé Publique (FR-T), Laboratoire de Microbiologie (P Legrand), and Unité de Contrôle-Epidémiologie-Prévention de ℓ'Infection (CEPI) (P Lesprit), Hôpital Henri Mondor (APHP), Créteil, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Zarrouk
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Françoise
authors.initials: F
authors.lastname: Roudot-Thoraval
authors.forename: Dora
authors.initials: D
authors.lastname: Bachir
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Patrick
authors.initials: P
authors.lastname: Legrand
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.forename: Frédéric
authors.initials: F
authors.lastname: Galacteros
authors.forename: Philippe
authors.initials: P
authors.lastname: Lesprit
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001847:Bone Diseases / Q000209:etiology* / Q000382:microbiology; D002406:Catheterization, Peripheral / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007592:Joint Diseases / Q000209:etiology* / Q000382:microbiology; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000209:etiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents