{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:59:47Z","timestamp":1789016387909,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T00:00:00Z","timestamp":1604102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with sickle cell disease are at higher risk of infections with encapsulated bacteria due to immature immune responses and functional asplenia. We aimed to study our patient population for the emergence of gram\u2010negative organisms other than <jats:italic>Salmonella<\/jats:italic> as the cause of osteomyelitis and document a vast decrease in <jats:italic>Streptococcus pneumoniae<\/jats:italic> bacteremia rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a retrospective chart review of 158 patients with sickle cell disease registered at our hospital. Over a period of 13 years, every patient presenting to the emergency department (ED) with fever had their medical record reviewed for blood cultures, wound cultures, and magnetic resonance imaging results for osteomyelitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The number of patients presenting to the ED with fever was 105, with 581 febrile episodes and 893 blood cultures. Among those, no culture grew <jats:italic>Streptococcus pneumoniae<\/jats:italic>, 14 grew coagulase\u2010negative staphylococci (1.5%), one grew <jats:italic>Salmonella enterica<\/jats:italic> Paratyphi B, and three grew <jats:italic>Salmonella enterica<\/jats:italic> group C (in the same patient). The total number of osteomyelitis episodes in patients with sickle cell disease presenting with fever and documented by imaging was nine (1.5%). In patients with osteomyelitis, organisms were isolated in four patients (44%), including <jats:italic>Enterobacter cloacae<\/jats:italic>, <jats:italic>Bacteroides<\/jats:italic>, <jats:italic>Pseudomonas aeruginosa<\/jats:italic>, and <jats:italic>Salmonella enterica<\/jats:italic> group C.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Immunization against <jats:italic>Streptococcus pneumoniae<\/jats:italic> and the use of prophylactic penicillin has virtually eliminated pneumococcal bacteremia among our patients. We observed the emergence of gram\u2010negative organisms other than <jats:italic>Salmonella<\/jats:italic> as the cause of osteomyelitis in patients with sickle cell disease.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28784","type":"journal-article","created":{"date-parts":[[2020,10,31]],"date-time":"2020-10-31T12:15:43Z","timestamp":1604146543000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Emergence of gram\u2010negative organisms as the cause of infections in patients with sickle cell disease"],"prefix":"10.1002","volume":"68","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7326-0477","authenticated-orcid":false,"given":"Sara","family":"Khalife","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8870-2159","authenticated-orcid":false,"given":"Rima","family":"Hanna\u2010Wakim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rasha","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5080-7441","authenticated-orcid":false,"given":"Rachid","family":"Haidar","sequence":"additional","affiliation":[{"name":"Department of Surgery American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7710-5121","authenticated-orcid":false,"given":"Peter G.","family":"Makhoul","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8668-9600","authenticated-orcid":false,"given":"Nabil","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5813-5878","authenticated-orcid":false,"given":"Ghassan","family":"Dbaibo","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8469-6823","authenticated-orcid":false,"given":"Miguel R.","family":"Abboud","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine American University of Beirut Medical Center  Beirut Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,10,31]]},"reference":[{"issue":"2","key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"156","DOI":"10.5581\/1516-8484.20120036","article-title":"Osteoarticular involvement in sickle cell disease","volume":"34","author":"da Silva Junior GB","year":"2012","journal-title":"Rev Bras Hematol 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