Children with short bowel syndrome at high risk for polymicrobial CLABSI

Issue: May 2011

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 settings.”

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 disclosures.

For more information:

Herrera Guerra A. #496. Presented at: SHEA 2011 Annual Scientific Meeting; April 1-4, 2011; Dallas.

Follow InfectiousDiseaseNews.com on Twitter.