Common causes of bacteraemia among sickle cell anaemia children with fever: evidence from a cross section survey.

Introduction:Sickle cell anaemia is an important cause of morbidity and mortality among Zambian children, with a carrier frequency ranging from 6% – 27%. Infections are the most common cause of mortality among sickle cell children aged between one to five years, accounting for about 30% of the mortalities. The objective of the study was to examine the current pattern of bacteraemia among Zambian sickle cell anaemia children presenting with fever at the University teaching hospital.Methods:The study was undertaken at the paediatric department of the University Teaching Hospital with a descriptive cross sectional approach. I undertook blood and urine cultures on all sickle cell anaemia patients younger than 15yrs with fever of 38oC and above, admitted to the UTH during the period April 2009 to November 2009.Results:Out of 199 sickle cell anaemia children admitted during the study period, 55 of them had fever of 38oC or more, accounting for 27.6% of the sickle cell admissions. The mean age of participants was 7.5years. Over 50% of the patients were aged between one and five years with a male to female ratio of 1.2:1. The majority of the patients (56.4%) came from high density residential areas. Vaso-occlussive crisis was the most common diagnosis on admission, accounting for 63%, followed by pneumonia (12.7%). 38.7% of the participants reported antibiotic use prior to presentation to hospital. The most common antibiotic used was amoxicillin (60%), followed by chloramphenicol (15%).
About 10% of the participants had confirmed bacterial infection on culture. 7.3% of the infections were due to urinary tract infection whereas 1.8% had bacteraemia. The organisms isolated included escherichia coli, citrobacter diversus, enterobacter aerogens and streptococcus species. The organisms were susceptible to Cefotaxime and Norfloxacin, Penicillin and Nalidixic acid.
Another 5.5% of the patients had clinical, laboratory and radiological evidence strongly suggestive of bacterial infection.
Conclusion:The proportion of bacterial infections among sickle cell anaemia with fever in this study was about 10%, with bacteraemia accounting for 1.8% of the study participants.