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Prevalence of Bloodstream Infections in Children With Short-Bowel Syndrome With a Central Line Presenting to

Amanda C Fifi1, Liz Bayes2, Eli D Ehrenpreis1,3

  • 1University of Miami Miller School of Medicine, Miami, Florida, USA.

JPEN. Journal of Parenteral and Enteral Nutrition
|September 13, 2019
PubMed

Insights

Children with short-bowel syndrome (SBS) face high bloodstream infection (BSI) risks. Elevated C-reactive protein (CRP) increases BSI odds, but white blood cell (WBC) count does not predict infection in these children.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Critical Care Medicine

Background:

  • Short-bowel syndrome (SBS) in children is associated with significant morbidity and mortality, primarily due to bloodstream infections (BSIs).
  • Understanding the prevalence and predictors of BSIs is crucial for timely intervention in pediatric SBS patients.

Purpose of the Study:

  • To determine the prevalence of bloodstream infections (BSIs) in children with short-bowel syndrome (SBS) presenting with fever.
  • To identify potential predictors of BSIs in this vulnerable pediatric population.

Main Methods:

  • A retrospective cohort study analyzed 246 patient encounters at Holtz Children's Hospital between April 2009 and June 2014.
  • Data reviewed included vital signs, white blood cell (WBC) count, C-reactive protein (CRP) levels, and blood/urine cultures.
  • Statistical analysis assessed BSI prevalence and the association between WBC/CRP levels and BSI risk.

Main Results:

  • The adjusted prevalence of BSI in febrile children with SBS was 55% (95% CI, 42.3%-65.4%).
  • Common pathogens included gram-negative (72.6%), gram-positive (29.3%), and fungal (10.8%) organisms.
  • Each 10-unit increase in CRP above 20 mg/L correlated with a 26% increase in BSI odds; WBC count showed no association.

Conclusions:

  • Febrile children with SBS are at high risk for diverse BSIs (gram-positive, gram-negative, fungal).
  • WBC count is an unreliable predictor of BSI; elevated CRP has limited predictive value despite increased odds.
  • Urgent broad-spectrum antibiotic treatment is recommended for children with SBS and fever.
Abstract

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