{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:27:58Z","timestamp":1787311678103,"version":"build-2736575974"},"reference-count":20,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,6,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                    <jats:p>Previous studies have indicated that febrile children with sickle cell disease (SCD) had a 3% to 5% risk of being bacteremic due to compromised immune function. The introduction of routine penicillin prophylaxis and conjugate vaccines may have lowered the risk of bacteremia. Our goals were to determine the rate of bacteremia among children with SCD per febrile episode and to estimate the safety of outpatient management among these febrile SCD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This 18-year retrospective cohort study included febrile SCD patients who presented to Boston Children\u2019s Hospital between 1993 and 2010.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>A total of 1118 febrile episodes were evaluated. Nine blood specimens had growth of a pathogen in culture (0.8%; 95% confidence interval: 0.3%\u20131.3%). Of the 466 febrile patients initially managed as outpatients, 3 were bacteremic (0.6%). All 3 received intravenous ceftriaxone at the initial outpatient visit and returned when contacted after growth of bacteria was detected in the blood culture. Upon return to the hospital, none were \u201cill appearing,\u201d required supportive care, or were admitted to an ICU.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Our rate of bacteremia among febrile children with SCD is much lower than previous estimates, and there was no associated morbidity or mortality among the patients managed as outpatients. A well-appearing febrile child with SCD may be managed as an outpatient after blood is obtained for bacterial culture and parenteral antibiotics are administered, provided there are no other reasons for admission and the patient is able to return promptly for worsening condition or for growth of a pathogen from their blood culture.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2012-2139","type":"journal-article","created":{"date-parts":[[2013,5,13]],"date-time":"2013-05-13T20:59:31Z","timestamp":1368478771000},"page":"1035-1041","source":"Crossref","is-referenced-by-count":72,"title":["Bacteremia Risk and Outpatient Management of Febrile Patients With Sickle Cell Disease"],"prefix":"10.1542","volume":"131","author":[{"given":"Marc N.","family":"Baskin","sequence":"first","affiliation":[{"name":"Divisions of Emergency Medicine,"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin Lyn","family":"Goh","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Heeney","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and"},{"name":"Hematology\/Oncology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marvin B.","family":"Harper","sequence":"additional","affiliation":[{"name":"Divisions of Emergency Medicine,"},{"name":"Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and"},{"name":"Infectious Diseases Department of Medicine, Boston Children\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2013,6,1]]},"reference":[{"issue":"3","key":"2021120900391482700_B1","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1097\/00006565-199406000-00005","article-title":"The presentation, frequency, and outcome of bacteremia among children with sickle cell disease and fever.","volume":"10","author":"West","year":"1994","journal-title":"Pediatr Emerg Care"},{"issue":"4","key":"2021120900391482700_B2","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1097\/00043426-200205000-00012","article-title":"Predictors of bacteremia in febrile children with sickle cell disease.","volume":"24","author":"West","year":"2002","journal-title":"J Pediatr Hematol Oncol"},{"issue":"7","key":"2021120900391482700_B3","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1056\/NEJM199308123290705","article-title":"A randomized study of outpatient treatment with ceftriaxone for selected febrile children with sickle cell disease.","volume":"329","author":"Wilimas","year":"1993","journal-title":"N Engl J Med"},{"issue":"5","key":"2021120900391482700_B4","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1016\/S0022-3476(05)83330-X","article-title":"Outpatient management of febrile illness in infants and young children with sickle cell anemia.","volume":"117","author":"Rogers","year":"1990","journal-title":"J Pediatr"},{"issue":"25","key":"2021120900391482700_B5","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1056\/NEJM198606193142501","article-title":"Prophylaxis with oral penicillin in children with sickle cell anemia: a randomized trial.","volume":"314","author":"Gaston","year":"1986","journal-title":"N Engl J Med"},{"issue":"2","key":"2021120900391482700_B6","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/S0022-3476(80)80802-X","article-title":"Fever in young children with sickle cell disease.","volume":"96","author":"McIntosh","year":"1980","journal-title":"J Pediatr"},{"issue":"3","key":"2021120900391482700_B7","first-page":"267","article-title":"Natural history of sickle cell disease\u2014the first ten years.","volume":"12","author":"Powars","year":"1975","journal-title":"Semin Hematol"},{"issue":"2","key":"2021120900391482700_B8","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1182\/blood.V86.2.776.bloodjournal862776","article-title":"Clinical events in the first decade in a cohort of infants with sickle cell disease.","volume":"86","author":"Gill","year":"1995","journal-title":"Blood"},{"issue":"4","key":"2021120900391482700_B9","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1001\/archpedi.1978.02120290068013","article-title":"Leukocyte counts in children with sickle cell disease: comparative values in the steady state, vaso-occlusive crisis, and bacterial infection.","volume":"132","author":"Buchanan","year":"1978","journal-title":"Am J Dis Child"},{"issue":"17","key":"2021120900391482700_B10","doi-asserted-by":"crossref","first-page":"3447","DOI":"10.1182\/blood-2009-07-233700","article-title":"Improved survival of children and adolescents with sickle cell disease.","volume":"115","author":"Quinn","year":"2010","journal-title":"Blood"},{"key":"2021120900391482700_B11","volume-title":"Division of Blood Diseases and Resources. 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