Background: Bordetella holmesii is a respiratory pathogen, known to cause bacteremia predominantly among patients with functional or anatomical asplenia. Currently, there is no consensus on optimal treatment for B. holmesii infection nor are there established interpretative criteria. This study aims to describe treatment of pediatric patients diagnosed with B. holmesii bacteremia, and treatment outcomes, in order to help establish an optimal therapeutic strategy.
Methods: We conducted a retrospective chart review of pediatric patients with microbiologically confirmed B. holmesii bacteremia at Childrens Healthcare of Atlanta, 2011-2018. We extracted demographic and clinical information of the identified patients from the medical record, and evaluated antimicrobial choice, hospital days, and treatment outcomes.
Results: Seven patients were identified; all had sickle cell disease and five had moderate to severe asthma requiring controller medications. They presented to the emergency department with mild respiratory illness with fevers, but had hemodynamic stability. Peripheral blood cultures were obtained and intravenous ceftriaxone was administered as the empiric antibiotic therapy. Six patients were discharged home after evaluation, and one patient was admitted for treatment for acute chest syndrome with venoocclusive crisis (see figure). When the blood cultures grew B. holmesii, previously discharged patients were called back for follow-up; three were admitted, and only one patient had a subsequent blood culture growing B. holmesii. Hospitalization days ranged from 3 to 5 days, and two patients went home with oral ciprofloxacin at the time of discharge. Total antibiotic days ranged from 1 to 15 days among the seven patients. No one required an intensive level care, and all were asymptomatic without recurrence of B. holmesii infections at the post-discharge follow up.
Conclusion: In our pediatric patients with B. holmesii bacteremia, clinical recovery was favorable with no severe illness, despite widely different treatment regimens and length of therapy. The questions still remain regarding pathogenicity of B. holmesii infection and efficacy of antibiotic use.
S. J. Joo,
A. Camacho-Gonzalez, None
P. Jaggi, None
M. Gonzalez, None