Low serum citrulline concentration correlates with catheter-related bloodstream infections in children with
Melissa A Hull1, Brian A Jones, David Zurakowski
1Center for Advanced Intestinal Rehabilitation, Children’s Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Insights
Low serum citrulline levels and prolonged central venous catheter use are linked to catheter-related bloodstream infections (CRBSIs) in children with intestinal failure. This suggests citrulline may predict CRBSI risk in these patients.
Area of Science:
- Pediatric Gastroenterology
- Clinical Nutrition
- Infectious Disease Epidemiology
Background:
- Serum citrulline is a biomarker for enterocyte mass and enteral tolerance.
- Low citrulline correlates with bacteremia in transplant patients.
- This study investigates citrulline's association with catheter-related bloodstream infections (CRBSIs) in pediatric intestinal failure.
Purpose of the Study:
- To determine if serum citrulline concentration is associated with CRBSI development in children with intestinal failure.
- To evaluate serum citrulline as a potential biomarker for CRBSI risk.
Main Methods:
- Retrospective review of 66 children with intestinal failure requiring parenteral nutrition (PN).
- Serum citrulline levels measured between January 2007 and August 2009.
- Exclusion criteria: <30 days central venous catheter, low creatinine clearance, or immunosuppression.
Main Results:
- 51 children met inclusion criteria; 26 (51%) developed CRBSIs.
- Mean minimum serum citrulline was significantly lower in patients with CRBSIs (6.7 ± 4.6 µmol/L) vs. without (11.3 ± 6.4 µmol/L).
- Lower citrulline and longer catheter duration were independently associated with CRBSI.
Conclusions:
- Low serum citrulline concentration and prolonged central venous catheter use are independently associated with CRBSI in pediatric intestinal failure.
- Serum citrulline may serve as a valuable biomarker for identifying high-risk patients for CRBSI.
Background:
Serum citrulline concentration is used as a biomarker of enterocyte mass and enteral tolerance, and low serum concentrations are correlated with bacteremia in immunosuppressed adults undergoing hematopoietic stem cell transplant. The authors sought to determine if citrulline was associated with the development of catheter-related bloodstream infections (CRBSIs) in children with intestinal failure.
Methods:
Data were reviewed from 66 children treated in a multidisciplinary intestinal rehabilitation program, who had serum concentration citrulline measured between January 2007 and August 2009. All patients had a diagnosis of intestinal failure requiring parenteral nutrition (PN) support. Exclusion criteria included central venous catheter in situ <30 days, creatinine clearance <20 mL/minute, or a history of organ transplant/immunosuppression.
Results:
A total of 15 patients were excluded because of the above criteria. In this cohort of 51 patients, 26 (51%) developed CRBSIs. Both groups were similar in terms of gestational age, diagnosis, nutrition status, and biochemical liver function tests. The mean (± standard deviation [SD]) minimum serum citrulline concentration was significantly lower in patients who developed CRBSIs (6.7 ± 4.6 µmol/L) than in those who did not (11.3 ± 6.4 µmol/L, P = .004). Multivariate logistic regression analysis identified lower minimum serum citrulline concentration and longer central venous catheter duration as independently associated with CRBSI (P = .003 and P = .038, respectively).
Conclusions:
Low serum citrulline concentration and longer central venous catheter time are independently associated with CRBSI in children with intestinal failure. Serum citrulline concentration may be a useful biomarker to identify patients with intestinal failure who are at high risk of developing a CRBSI.
Related Concept Videos
01:24Serum Studies: Renal Function Tests
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:26Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy
01:30Continuous Renal Replacement Therapy
01:25Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance