Acute chest syndrome (ACS) in sickle cell disease (SCD) is life-threatening and characterised by a new infiltrate on imaging plus fever or respiratory symptoms.1 Causes of ACS include infections, venous or fat embolisms or local sickling.

Infections are responsible for about a third of ACS episodes in children, less in adults and only a minority of episodes are due to typical bacteria.

Nonetheless, due to its clinical and radiologic resemblance to pneumonia, difficulty in distinguishing infectious from non-infectious aetiologies and its potential for rapid deterioration, antibiotic treatment is often initiated early.

The ANTIBIO-STA trial was performed in two French hospitals.

Adult patients with ACS were randomized to an interventional or conventional strategy.

All patients received standard microbial testing including cultures from lower respiratory tract samples (LRTS).

In the intervention group a LRTS was also tested with a multiplex PCR (mPCR) for viruses and bacteria and PCT was measured serially to guide antibiotic use.

Of 72 enrolled patients 81.9% were in the intensive care unit (ICU), 79.2% had already received antibiotics.

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