title: Predictors for bacteremia in febrile sickle cell disease children in the post-7-valent pneumococcal conjugate vaccine era.
abstract: OBJECTIVE
  The objective of this study was to determine the incidence of bacteremia in febrile sickle cell disease (SCD) children before and after the 7-valent pneumococcal vaccine (PCV7), and to determine clinical factors associated with bacteremia following PCV7.
  
  
  METHODS
  We reviewed all febrile events in SCD children from 1993 to 2009 at a tertiary care pediatric center, comparing general bacteremia and pneumococcal bacteremia incidence for 3 time periods around the PCV7. Univariate analysis and stepwise logistic regression identified clinical factors most associated with bacteremia in this population.
  
  
  RESULTS
  Of 466 SCD children identified, there were 2504 febrile events. We found 84 cases of bacteremia; 8 were pneumococcal. The general bacteremia incidence decreased significantly from 5.60% to 2.44% (P<0.001) over time. Pneumococcal bacteremia incidence did not decrease (P=0.13). Following PCV7, we identified 4 significant independent risk factors associated with general bacteremia: the presence of a central venous line, higher absolute band count, toxic appearance, and older age.
  
  
  CONCLUSIONS
  In febrile SCD children, the incidence of general bacteremia decreased over time. No decrease in pneumococcal bacteremia was found. The presence of a central venous line, absolute band count, clinical appearance, and age may help predict bacteremia in this population.
authors.affiliation: Division of Emergency Medicine and Transport, Children's Hospital Los Angeles, Los Angeles, CA 90027, USA. dr.toddchang@gmail.com
authors.forename: Todd P
authors.initials: TP
authors.lastname: Chang
authors.forename: Worapant
authors.initials: W
authors.lastname: Kriengsoontorkij
authors.forename: Linda S
authors.initials: LS
authors.lastname: Chan
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications*; D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D049690:History, Ancient; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines