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Antibiotic Therapy for Culture-Proven Bacterial Overgrowth in Children With Intestinal Failure Results in Improved
Katherine Culbreath1,2, Jamie Knell1,2, Gregory Keefe1,2
1From the Center for Advanced Intestinal Rehabilitation, Boston Children's Hospital, Boston, MA.
Insights
Pediatric patients with intestinal failure and small bowel bacterial overgrowth experienced improved symptoms and BMI after targeted antibiotic therapy. Further research is needed to assess long-term growth and antibiotic resistance.
Area of Science:
- Pediatric Gastroenterology
- Intestinal Rehabilitation
- Microbiome Research
Background:
- Small bowel bacterial overgrowth (SBBO) is a common complication in pediatric patients with intestinal failure (IF).
- SBBO can exacerbate symptoms, impair enteral tolerance, and affect growth in this vulnerable population.
- Current treatment strategies for SBBO in IF patients often involve antibiotic therapy, but optimal regimens and outcomes require further investigation.
Purpose of the Study:
- To evaluate the impact of targeted antibiotic therapy on symptoms, enteral tolerance, and growth in pediatric IF patients with culture-proven SBBO.
- To analyze the antibiotic regimens used and their variability in this patient cohort.
- To identify areas for future research in managing SBBO in pediatric IF.
Main Methods:
- A single-center retrospective review was conducted on pediatric patients (0-18 years) diagnosed with IF and SBBO (duodenal cultures >10^5 CFU/mL) between 2010 and 2017.
- Clinical data, including symptoms, enteral tolerance, growth parameters (BMI-for-age z-scores), and antibiotic regimens, were collected at baseline and 6 months post-treatment.
- Statistical analysis was performed to compare outcomes before and after targeted antibiotic therapy.
Main Results:
- Of 78 patients with positive duodenal cultures, data from 56 were analyzed. Following targeted antibiotic treatment, significant improvements were observed in emesis/feeding intolerance (58.9% vs 23.2%), abdominal pain (16.1% vs 7.1%), high stool output (42.9% vs 19.6%), and GI bleeding (19.6% vs 3.6%).
- Mean BMI-for-age z-scores significantly increased post-therapy (-0.03 ± 0.94 vs 0.27 ± 0.82).
- No significant changes were noted in height-for-age z-scores, weight-for-age z-scores, or the percentage of enteral calories. Antibiotic regimens were highly variable.
Conclusions:
- Targeted antibiotic therapy following duodenal culture is effective in improving symptoms and BMI-for-age z-scores in pediatric IF patients with SBBO.
- Longer follow-up periods may be necessary to ascertain effects on linear growth and enteral feeding independence.
- Further prospective studies are crucial to standardize diagnostic techniques, correlate findings with pathology, and evaluate antibiotic resistance patterns in this population.
Objectives:
To evaluate symptoms, enteral tolerance, growth, and antibiotic regimens in pediatric intestinal failure (IF) patients after treated with antibiotic therapy for small bowel bacterial overgrowth (SBBO).
Methods:
Single-center retrospective review of children 0-18 years with IF with endoscopic cultures demonstrating >10 5 CFU/mL from 2010 to 2017. Symptoms, enteral tolerance, growth, and antibiotic regimens were evaluated at the time of endoscopy and 6 months later.
Results:
Of 505 patients followed in our intestinal rehabilitation program, 104 underwent upper gastrointestinal endoscopy and 78 had positive duodenal cultures. Clinical data pre- and post-endoscopy were available for 56 patients. Compared to baseline, in the 6 months following targeted antibiotic treatment, children showed significant improvement in emesis or feeding intolerance (58.9% vs 23.2%, P < 0.001), abdominal pain (16.1% vs 7.1%, P = 0.02), high stool output (42.9% vs 19.6%, P = 0.002), and gross GI bleeding (19.6% vs 3.6%, P = 0.003). Mean BMI-for-age z scores increased significantly (-0.03 ± 0.94 vs 0.27 ± 0.82, P = 0.03); however, height-for-age z scores, weight-for-age z scores, and percent of calories from enteral intake were not significantly different after therapy. Antibiotic regimens remained highly variable.
Conclusions:
Children with IF and culture-positive SBBO showed significant improvement in symptoms and BMI-for-age z scores after duodenal culture with subsequent targeted antibiotic therapy. Longer follow-up may be needed to detect improvements in linear growth and percent of calories from enteral feeds. Antibiotic regimens remain highly variable. Long-term consequences of chronic antimicrobial therapy, including antimicrobial resistance, remain unknown. Prospective studies focused on standardizing duodenal sampling technique, correlating culture and pathology data, and evaluating antibiotic resistance patterns are needed.
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