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

Talal B Seddik1, Lu Tian2, Colleen Nespor3

  • 1Pediatric Infectious Diseases, Stanford University, Stanford, California, USA.

JPEN. Journal of Parenteral and Enteral Nutrition
|June 11, 2019
PubMed

Insights

Children with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) face a high risk of ambulatory central line-associated bloodstream infections (A-CLABSI). Small intestine bacterial overgrowth (SIBO) and central line (CL) breaks significantly increase A-CLABSI risk in these patients.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Clinical Nutrition

Background:

  • Children with short bowel syndrome (SBS) are susceptible to ambulatory central line-associated bloodstream infections (A-CLABSI) during home parenteral nutrition (HPN).
  • Limited data exist on specific risk factors for A-CLABSI in this pediatric population.

Purpose of the Study:

  • To identify risk factors associated with A-CLABSI in children with SBS receiving HPN.
  • To inform prevention strategies for A-CLABSI in pediatric SBS patients.

Main Methods:

  • Retrospective cohort, case-crossover study of pediatric SBS patients (≤18 years) on HPN (2012-2016).
  • Univariate and multivariate mixed-effects Poisson regression analyzed relative risk (RR) of A-CLABSI.
  • Identified risk factors including age, small intestine length, citrulline levels, central line (CL) breaks, and small intestine bacterial overgrowth (SIBO).

Main Results:

  • A-CLABSI rate was 4.2 per 1000 CL days.
  • Univariate analysis linked younger age, shorter small intestine, lower citrulline, and recent CL breaks to increased A-CLABSI risk.
  • Multivariate analysis identified clinical SIBO diagnosis (RR: 1.87) and CL breaks (RR: 1.49) as significant risk factors for A-CLABSI.

Conclusions:

  • Factors affecting gut integrity, such as SIBO, increase A-CLABSI risk, suggesting translocation as a key mechanism.
  • Central line maintenance and preventing CL breaks are crucial for reducing A-CLABSI rates.
  • Further research is needed to clarify the role of dysbiosis versus diarrhea in SIBO-associated A-CLABSI.
Abstract

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