Incidence of catheter-associated gram-negative bacteremia in children with short bowel syndrome

Abstract

Children with catheter-associated bacteremia were evaluated for the type of bacteria recovered and the relationship of the bacteria to the predisposing disease. A previously unrecognized observation was that gram-negative isolates, namely, Escherichia coli and Klebsiella sp., were almost exclusively recovered (11 of 12 isolates [92%]) from children with short bowel syndrome (SBS) compared with those from children with other underlying diseases, such as inflammatory bowel disease, malignancies, and other disorders (P < 0.001). Furthermore, children with SBS had a higher frequency of repeated infection (3.1 catheter-associated infections compared with 1.3 catheter-associated infections in children with other disorders during the same period). Only gram-positive bacteria were isolated from children with malignancies and other predisposing disorders. The very high frequency of catheter-associated gram-negative bacteremia in children with SBS compared with that in children with other bowel disorders, malignancies, and other predisposing diseases requires attention by the clinician in the management of patients in this group.

Prospective Cohort Study of the Outcome of and Risk Factors for Intravascular Catheter‐Related Bloodstream Infections in Children With Intestinal Failure

“…Children with intestinal failure (IF) have a high incidence of catheter‐related bloodstream infections (CRBSIs) 1 , 2 . Administration of parenteral nutrition (PN) appears to contribute, 3 potentiated by the fact that gut mucosal integrity 4 and secretion of IgA 5 are impaired with PN.…”

Pediatric Intestinal Failure Review

“…Infection and inflammation negatively contribute to cholestasis in infants. Catheter related blood stream infection is a major cause of morbidity and mortality, and occurs in high frequency in children with IF who require long term vascular access for PN [ 37 ]. The incidence of CRBSI in pediatric patients with IF has been reported as high as 80% [ 38 ].…”

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

“…In children, the most common etiology of SBS is extensive intestinal resection performed for the treatment of congenital gastrointestinal malformations or necrotizing enterocolitis [3]. Infants and children affected by SBS carry a high burden of complications related to their initial surgical management, the resulting malabsorptive state, and their need for parenteral nutrition [1][2][3][4][5][6][7][8]. These include watery diarrhea, bloodstream infections (BSIs), electrolyte disturbances, catheter-related complications, liver and biliary diseases, complications of bacterial overgrowth (arthritis, colitis, D-lactic acidosis), nutritional deficiencies, and enteric hyperoxaluria [9].…”