Epidemiologic Associations Between Short-Bowel Syndrome and Bloodstream Infection Among Hospitalized Children

Miko, Benjamin A.; Kamath, Suma S.; Cohen, Bevin; Jeon, Christie Y.; Jia, Haomiao; Larson, Elaine

doi:10.1093/jpids/piu079

Cited by 24 publications

(16 citation statements)

References 16 publications

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“…For example, pediatric patients with short gut syndrome, who are dependent upon parenteral nutrition, are at high risk for recurrent central line infections and thus may have higher cumulative antibiotic exposure than even some critical care and oncology patients. [34][35][36][37] For such patients, pathogens causing CLABSIs may be more likely to be antibiotic resistant. Other potential explanations include differences in infection control practices or opportunities for transmission in pediatric ward locations compared to critical care or oncology locations.…”

Section: Discussionmentioning

confidence: 99%

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Lake

Weiner

Milstone

et al. 2017

Infect. Control Hosp. Epidemiol.

136

103

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OBJECTIVETo describe pathogen distribution and antimicrobial resistance patterns for healthcare-associated infections (HAIs) reported to the National Healthcare Safety Network (NHSN) from pediatric locations during 2011–2014.METHODSDevice-associated infection data were analyzed for central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated pneumonia (VAP), and surgical site infection (SSI). Pooled mean percentage resistance was calculated for a variety of pathogen-antimicrobial resistance pattern combinations and was stratified by location for device-associated infections (neonatal intensive care units [NICUs], pediatric intensive care units [PICUs], pediatric oncology and pediatric wards) and by surgery type for SSIs.RESULTSFrom 2011 to 2014, 1,003 hospitals reported 20,390 pediatric HAIs and 22,323 associated pathogens to the NHSN. Among all HAIs, the following pathogens accounted for more than 60% of those reported: Staphylococcus aureus (17%), coagulase-negative staphylococci (17%), Escherichia coli (11%), Klebsiella pneumoniae and/or oxytoca (9%), and Enterococcus faecalis (8%). Among device-associated infections, resistance was generally lower in NICUs than in other locations. For several pathogens, resistance was greater in pediatric wards than in PICUs. The proportion of organisms resistant to carbapenems was low overall but reached approximately 20% for Pseudomonas aeruginosa from CLABSIs and CAUTIs in some locations. Among SSIs, antimicrobial resistance patterns were similar across surgical procedure types for most pathogens.CONCLUSIONThis report is the first pediatric-specific description of antimicrobial resistance data reported to the NHSN. Reporting of pediatric-specific HAIs and antimicrobial resistance data will help identify priority targets for infection control and antimicrobial stewardship activities in facilities that provide care for children.Infect Control Hosp Epidemiol 2018;39:1–11

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Section: Discussionmentioning

confidence: 99%

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Lake

Weiner

Milstone

et al. 2017

Infect. Control Hosp. Epidemiol.

136

103

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“…CVCs are ubiquitous in patients with intestinal failure as a means for survival in patients who require PN and/or fluids to allow appropriate growth and development. Short bowel syndrome was the single strongest predictor for risk of bloodstream infections in a retrospective review of 40,723 pediatric hospital admission with 1047 diagnoses of bloodstream infections, in which 20% included a short bowel syndrome diagnosis 94 . In a systemic review of patients with intestinal failure, ethanol vs heparin locks have been shown to be more effective at reducing the number of CLABSIs as well as reducing the rate of catheter removals 95 .…”

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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“…Children with SBS are at high risk for ambulatory central line–associated bloodstream infection (A‐CLABSI) because of prolonged requirement for central lines (CLs) to deliver home parenteral nutrition (HPN) . A‐CLABSI differs from healthcare‐associated central line–associated bloodstream infection (HAI‐CLABSI) in characteristics and risk factors . Children with SBS and malignancy are the main populations at risk for A‐CLABSI, as both require prolonged central access.…”

Section: Introductionmentioning

confidence: 99%

“…Children with SBS and malignancy are the main populations at risk for A‐CLABSI, as both require prolonged central access. Indeed, 46% of hospitalizations of children with SBS are due to A‐CLABSI, representing 20% of all admissions due to bloodstream infection (BSI) in pediatrics . Furthermore, A‐CLABSI was found 3 times more commonly than HAI‐CLABSI in pediatric oncology patients, and 13% of their admissions were to the pediatric intensive care unit .…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Seddik

Tian

Nespor

et al. 2019

J Parenter Enteral Nutr

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Background Children with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) are predisposed to ambulatory central line–associated bloodstream infection (A‐CLABSI). Data describing risk factors of this infection in children are limited. Methods Retrospective cohort, single‐center, case‐crossover study of children ≤18 years old with SBS receiving HPN from January 2012 to December 2016. Univariate and multivariate mixed effect Poisson regression identified the relative risk (RR) of A‐CLABSI with proposed risk factors. Results Thirty‐five children were identified; median follow‐up was 30 months. A‐CLABSI rate was 4.2 per 1000 central line (CL) days. Univariate analysis identified younger age (RR: 0.92 per 12‐month increase [95% confidence interval {CI}: 0.85‐0.99; P = 0.036]), shorter small intestine length (RR: 0.96 per 10‐cm increase [95% CI: 0.92‐0.99; P = 0.008]), lower citrulline level (RR: 0.86 per 5‐nmol/mL increase [95% CI: 0.75‐0.99; P = 0.036]), and recent CL break (RR: 1.55 [95% CI: 1.06‐2.28; P = 0.024]) as risk factors for A‐CLABSI. Multivariate analysis showed increased A‐CLABSI with clinical diagnosis of small intestine bacterial overgrowth (SIBO) (RR: 1.87 [95% CI: 1.1‐3.17; P = 0.021]) and CL breaks (RR: 1.49 [95% CI: 1‐2.22; P = 0.024]). Conclusions Factors influencing gut integrity increase A‐CLABSI rate, supporting translocation as an important mechanism and target for prevention. Clinical diagnosis of SIBO increases A‐CLABSI rate, but whether dysbiosis or diarrhea is responsible is an area for future research. CL maintenance is crucial, and prevention of breaks would likely decrease A‐CLABSI rate.

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Epidemiologic Associations Between Short-Bowel Syndrome and Bloodstream Infection Among Hospitalized Children

Abstract: While several clinical characteristics are contributory to the risk of BSI in children, SBS remains the single strongest predictor. Further research into the mediators of this risk will be essential for the development of prevention strategies for this vulnerable population.

Cited by 24 publications

References 16 publications

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Pathogen Distribution and Antimicrobial Resistance Among Pediatric Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2011–2014

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

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