DALLAS — Preliminary results of a new study show
that children with short bowel syndrome are at high risk for central
line-associated bloodstream infections, according to a presenter here.
Central line-associated bloodstream infections (CLABSI)
are often polymicrobial and more likely caused by bacteria from the gut,
suggesting that intestinal translocation may have a central role in causing
these infections, the researchers reported.
“We found a surprising high rate of infections, and
that some children have multiple infections over time, while others escape
infection. It appears that some children are at much higher risk and experience
many line infections, while others do not,” said Angel A. Herrera
Guerra, MD, of the department of pediatrics at the University of Utah.
“When the study is complete, we hope that it will help us to determine
what empiric antibiotic therapy is the most appropriate in different
For the retrospective cohort study, Herrera Guerra and
colleagues set out to describe the incidence, microbiology and risk factors
associated with CLABSI in patients with short bowel syndrome at Primary
Children’s Medical Center, a tertiary care hospital in Salt Lake City.
From Jan. 1, 2004, to Oct. 18, 2010, the researchers
identified children with short bowel syndrome and included in the cohort those
who had a diagnosis of short bowel syndrome and received parenteral nutrition
for at least 30 days. Based on preliminary results, 104 patients had short
bowel syndrome, 55% of whom experienced 235 episodes of CLABSI. Of 235
episodes, 74% were monomicrobial and 25% were polymicrobial, with a median of
one pathogen per infection (range, 1 to 4).
Of the 61 polymicrobial infections, two pathogens were
found in 48 infections (79%), three pathogens were found in 10 infections (16%)
and four pathogens were found in three infections (5%). Among 310 positive
blood cultures, 55 different species of microorganisms were isolated, and
gram-positive cocci were most commonly isolated (60%), followed by enteric
gram-negatives (42%) and yeast (17%).
The most common gram-positive organisms were
Staphylococcus epidermidis and other coagulase-negative
staphylococci (25%), Enterococcus faecalis (11%), S. aureus
(4%) and E. faecium (4%); the most common gram-negative organisms were
Escherichia coli (8%) Enterobacter cloacae (8%), Klebsiella
oxytoca (6%) and K. pneumoniae (5%).
Candida infections were relatively common, with 5%
Candida albicans, 4% C. glabrata and 3% C. parapsilosis.
In addition, non-albicans Candida species accounted for 63% of yeast
isolates in this patient population, which has implications for the choice of
antifungal drug, according to Herrera Guerra.
“In view of our preliminary results, we think that
physicians should consider empirical anti-fungal therapy in [short bowel
syndrome] patients when CLABSI infections are suspected, especially if the
child has had recent antibiotic treatment. Parents should be well educated
about line care,” he said.
In addition, Herrera Guerra said parents should seek
immediate care if they suspect line infection when their child with short bowel
syndrome has a high fever.
“When CLABSI is suspected, parents should remind
providers to get one blood culture from the line and one from a peripheral
blood draw so that accurate diagnosis of CLABSI can be made,” he said.
Preventive strategies for these infections are needed in
high-risk populations, according to Herrera Guerra. “We hope by
identifying risk factors, we can identify potential measures to prevent CLABSIs
in children with [short bowel syndrome]. We have not yet looked at risk factors
but are hoping to conclude our data collection and analysis in the following 2
to 3 months,” he said. – by Ashley DeNyse
Disclosure: Dr. Herrera Guerra reports no relevant financial
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