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Epidemiologic Associations Between Short-Bowel Syndrome and Bloodstream Infection Among Hospitalized Children
Benjamin A Miko1, Suma S Kamath2, Bevin A Cohen3
1Division of Infectious Diseases, Department of Medicine.
Insights
Children with short bowel syndrome (SBS) have a significantly higher risk of bloodstream infections (BSI). SBS is the strongest predictor of BSI in hospitalized children, necessitating targeted prevention strategies.
Area of Science:
- Pediatric Infectious Diseases
- Gastroenterology
- Epidemiology
Background:
- Short bowel syndrome (SBS) in children is linked to high morbidity and mortality, often due to infectious diseases.
- Limited large-scale studies exist on factors predicting bacteremia in children with and without SBS.
Purpose of the Study:
- To investigate the epidemiological associations between short bowel syndrome (SBS) and bloodstream infections (BSI) in hospitalized children.
- To identify patient-specific risk factors for BSI in this pediatric population.
Main Methods:
- A case-control study was conducted using data from a prospective cohort of pediatric BSI cases and controls.
- The study included hospital admissions from three New York City hospitals.
Main Results:
- Children with SBS accounted for nearly 20% of all hospital admissions with BSI, despite representing only 0.2% of the overall cohort.
- SBS was the strongest predictor of BSI (odds ratio [OR] 19.0), followed by kidney injury (OR 6.67) and central venous catheter use (OR 6.36).
- Other significant factors included age 1-5 years, organ transplantation, cirrhosis, and admission from a skilled nursing facility.
Conclusions:
- Short bowel syndrome (SBS) is the most significant risk factor for bloodstream infections (BSI) in hospitalized children.
- Understanding the mediators of BSI risk in SBS patients is crucial for developing effective prevention strategies.
- Further research is needed to protect this vulnerable pediatric population from life-threatening infections.
Background:
Children with short bowel syndrome (SBS) suffer from strikingly high rates of morbidity and mortality, due in part to their susceptibility to life-threatening infectious diseases. Few large, multisite studies have evaluated patient-specific factors associated with bacteremia in hospitalized children with and without SBS.
Methods:
We conducted a case-control study to examine the epidemiological associations between SBS and bloodstream infections (BSI) in hospitalized children. Pediatric BSI cases and controls were selected from a prospective cohort study conducted at 3 New York City hospitals.
Results:
Among 40 723 hospital admissions of 30 179 children, 1047 diagnoses of BSI were identified. A total of 64 children had a diagnosis of SBS. BSI was identified frequently among hospitalizations for children admitted with SBS (n = 207/450, 46%) compared to hospitalizations for children without the condition (n = 840/40 273, 2.1%, P < .001). While this population represented only 0.2% of our overall cohort, it accounted for nearly 20% of all hospital admissions with BSI. Multivariable analysis identified 8 factors significantly associated with pediatric hospitalizations with BSI. These included a diagnosis of SBS (odds ratio [OR] 19.0), ages 1-5 years (OR 1.33), presence of a non-Broviac-Hickman central venous catheter (OR 6.36), immunosuppression (OR 0.53), kidney injury (OR 6.67), organ transplantation (OR 4.44), admission from a skilled nursing facility (OR 2.66), and cirrhosis (OR 7.23).
Conclusions:
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.
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