LAUSR

Background Children with sickle cell anemia (SCA) are highly susceptible to bacterial infections. While studies in Sub-Saharan Africa have explored the prevalence and causes of bacteremia in SCA, no such data exist from Uganda. This study aimed to determine the prevalence, bacterial causes, and associated factors of bacteremia among febrile children with SCA at Jinja Regional Referral Hospital (JRRH). Methods We conducted a cross-sectional study among febrile children ≤18 years with confirmed SCA at JRRH. Data on sociodemographic, clinical, and laboratory variables were collected from caregivers and medical records. Blood samples were cultured using the BACTEC FX200 system and sensitivity for Kirby-Bauer disk diffusion. Descriptive statistics reported prevalence and etiology. Binary logistic regression was used to identify factors associated with bacteraemia, using SPSS v26. Statistical significance was set at p < 0.05. Results Of the 209 febrile children enrolled, 114 (54.5%) were male and 116 (55.5%) were under five years. Bacteremia was confirmed in 44 patients (21.1%). The most frequent isolate was Staphylococcus aureus (25/44, 56.8%), followed by Escherichia coli (8/44, 18.2%), Klebsiella pneumoniae (3/44, 6.8%), and Haemophilus influenzae (3/44, 6.8%). All isolates were resistant to gentamicin, ampicillin, penicillin, and ofloxacin. S. aureus showed good sensitivity to cloxacillin. Factors associated with bacteremia were low maternal education (aOR = 1.098; 95% CI: 1.007–1.197; p = 0.037), tachycardia (aOR = 1.116; 95% CI: 1.027–1.213; p = 0.010) and neutrophilia (aOR = 1.536; 95% CI: 1.363–1.731; p < 0.001). Conclusion Bacteremia was common among febrile children with SCA, with Staphylococcus aureus as the leading isolate. Blood cultures should be prioritized. Ampicillin and gentamicin were ineffective, whereas cloxacillin, cefotaxime, and other antibiotics with demonstrated sensitivity are recommended as empiric alternatives.