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

Abstract

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.

Central line-associated blood stream infection (CLABSI) due to Candida sojae in an infant with short bowel syndrome: The first human case report

“…Factors affecting gut integrity increase the rate of CLABSI. This supports translocation as the main mechanism of infection in SBS patients [2] . Patients with SBS are also at high risk of polymicrobial infections, commonly due to organisms associated with gastrointestinal tract and the skin flora [2] .…”

“…This supports translocation as the main mechanism of infection in SBS patients [2] . Patients with SBS are also at high risk of polymicrobial infections, commonly due to organisms associated with gastrointestinal tract and the skin flora [2] . Candida infections are relatively common in this patient population, predominantly due to Candida albicans , and C. parapsilosis [3] .…”

How Broad Should Gram‐Negative Coverage Be for Febrile Parenteral Nutrition Dependent Short Bowel Syndrome Patients?

“…Prior analyses have identified potential risk factors for all cause CLABSI in community SBS patients (3,7), but risk factors for occurrence of Gram-negatives or resistant Gram-negatives versus infections lacking these pathogens have not been well defined. Additional analyses of risk factors for Gram-negative and resistant Gram-negative infections could help guide empiric antimicrobial selection.…”

Bacterial overgrowth assessment and treatment among pediatric intestinal rehabilitation and nutrition support providers: An international survey of clinical practice patterns

“…Many gastrointestinal symptoms, signs, and outcomes have been attributed to SBBO in children with SBS in case series or single-center reports, including micronutrient deficiency, central line-associated blood stream infection (CLABSI), gas, bloating, and diarrhea. [2][3][4][5][6] Variable symptoms and illnesses in the neurologic, dermatologic, renal, genitourinary, and rheumatologic systems have also been reported. 7,8 Frequently, the diagnosis of SBBO is identified clinically, with subsequent antibiotic therapy directed toward the presumed overgrowth of bacteria in the small bowel.…”