Study Finds Rare Atypical Bacteria in Pediatric SCD ACS, Underscoring Limited Utility of Empiric Macrolides

Key Findings

  • Purpose To determine the prevalence of atypical bacterial pathogens in children with sickle cell disease (SCD) presenting with acute chest syndrome (ACS) or pneumonia.
  • Population 6,762 U.S. children ≤18 years old with SCD and ACS/pneumonia ICD-10 codes, drawn from a multicenter inpatient dataset. Only 16–17% were tested for atypical organisms.
  • Headline Result Among those tested, prevalence of Mycoplasma pneumoniae was 1.1%, and Chlamydia pneumoniae ≤0.87%.
  • Why It Matters Current NHLBI guidelines recommend empiric cephalosporin plus macrolide coverage for ACS without requiring microbiologic confirmation. These findings suggest atypical infections are uncommon, raising concerns about overuse of macrolides and potential for unnecessary toxicity and antibiotic resistance.
  • Evidence Gaps Low testing rates prevent full understanding of atypical pathogen burden. Analysis relied on ICD-10 coding, which risks misclassification, incomplete capture of ACS events, and missing or undocumented test results.
Source: Journal of Sickle Cell Disease – Low prevalence of atypical bacterial pathogens among pediatric patients with sickle cell disease hospitalized for acute chest syndrome or pneumonia 

Regulatory & Guideline Watch

The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend empiric treatment of ACS with an intravenous cephalosporin and oral macrolide for pediatric patients with sickle cell disease. The findings of this study offer support for reevaluating guidelines, given the low prevalence of atypical pathogens. NHLBI Guidelines- https://www.nhlbi.nih.gov/sites/default/files/media/docs/sickle-cell-disease-report%20020816_0.pdf