Prevalence of penicillin-nonsusceptible Streptococcus pneumoniae in nasopharyngeal cultures from patients with sickle cell disease.

BACKGROUND: Prevention of pneumococcal sepsis in children with sickle cell disease (SCD) is threatened by the emergence of penicillin-nonsusceptible pneumococci. METHODS: In this study, nasopharyngeal colonization with Streptococcus pneumoniae and penicillin susceptibility were compared in children with SCD and a control group. Nasopharyngeal cultures were obtained from 130 children with SCD and 123 control children. Penicillin susceptibility was determined by Epsilometer test. Compliance with penicillin prophylaxis in SCD patients was determined by parent interviews and review of patients' medical and pharmacy records. RESULTS: Streptococcus pneumoniae was isolated from 8 (6%) of 130 SCD patients, and 21 (17%) of 123 control patients. Of the 29 S pneumoniae isolates, 6 (21%) were nonsusceptible to penicillin; 4 of 8 (50%) were from the SCD group and 2 of 21 (10%) from the control group. CONCLUSIONS: Penicillin prophylaxis decreased the rate of S pneumoniae colonization in SCD patients; however, it also increased the risk of selective colonization with penicillin-nonsusceptible S pneumoniae.

Pain intensity and home pain management of children with sickle cell disease.

The purpose of this study was to measure the pain intensity of children with sickle cell disease during vaso-occlusive episodes (VOEs) and to describe their home pain management techniques. This research was guided by Orem's (1991) Self-Care Deficit Theory of Nursing. The instruments used were the African American Oucher Scale (Denyes & Villarruel, 1990) and a pain diary. The study's convenience sample consisted of 30 4- to 18-year-old children attending the Sickle Cell Center at a large Midwestern children's hospital. At the onset of the VOE, 43% of the children reported intense pain levels, and 60% of the children reported levels comparable to that of someone experiencing minor surgery or injury. Older children tended to report higher levels of pain than younger children. There was no statistically significant difference according to gender. The most frequently used pain management tools were Tylenol with codeine, fluid, and ibuprofen. Other pain management techniques used fairly often included application of heat, sleeping, reading, and exercising. The only differences in pain levels associated with the management techniques used were that children who used heat (dry and/or moist) reported higher pain intensity prior to its application than those who did not. This study shows the importance of using an ethnic-appropriate scale to quantify the children's sickle cell pain, which was found to range from intense to minor in nature. The study also identifies numerous self-care actions that children use to manage their pain at home. The pain intensity experienced during VOEs may become worse with age. Evaluation of children's self-care behaviors during VOEs in the home is important because being able to remain in their normal environment helps convince the children that they have some control over their disease.