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Infection Prevention and Management in Pediatric Short Bowel Syndrome
Laura Merras-Salmio1,2, Mikko P Pakarinen2,3
1Pediatric Gastroenterology Unit, Children's Hospital, Helsinki University Hospital, Helsinki, Finland.
Insights
Short bowel syndrome (SBS) requires specialized care to prevent infections. Protocol-based approaches and multidisciplinary teams significantly reduce complications, improving outcomes for patients with intestinal failure.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Innovation
Background:
- Short bowel syndrome (SBS) is a rare condition leading to intestinal failure and serious complications.
- Central venous catheters (CVCs), essential for long-term access, pose risks of infection and thrombosis in SBS patients.
- Intestinal dysfunction in SBS increases susceptibility to bacterial overgrowth and mucosal injury.
Purpose of the Study:
- To outline an intestinal failure-specific approach for preventing and treating infections in SBS patients.
- To evaluate strategies for managing CVC-related complications in SBS.
- To highlight the role of protocol-based care and surgical interventions.
Main Methods:
- Review of infection prevention strategies, including antibiotic therapy and catheter lock solutions (taurolidine, ethanol).
- Assessment of CVC access procedures and daily care protocols.
- Consideration of reconstructive intestinal surgery for specific patient subsets.
- Evaluation of probiotic efficacy and risks.
Main Results:
- Protocol-based CVC care and specific catheter lock solutions significantly reduce infection rates.
- Antibiotic therapy can often salvage infected lines, but repeated replacements increase risks.
- Reconstructive surgery may be indicated for patients with excessive bowel dilatation and recurrent infections.
- Probiotics have shown limited efficacy and carry significant risks in SBS infection prevention.
Conclusions:
- A protocol-based, multidisciplinary approach is crucial for reducing complications in SBS patients.
- Effective management of CVCs and addressing intestinal dysfunction are key to improving patient outcomes.
- Further research is needed on infection prevention strategies tailored to SBS.
Abstract:
Short bowel syndrome (SBS) is a rare disease with potentially life-threatening consequences. In addition to intestinal failure-associated liver disease, infections and other complications related to central venous catheters (CVCs) cause a significant burden to patients with SBS and may even necessitate an intestinal transplant eventually. The need for long-term central venous access and the intestinal dysfunction associated with SBS drive the need for intestinal failure-specific approach to prevent and treat infections in patients with SBS. In bacterial infections, the line can often be salvaged with proficient antibiotic therapy. Repeated catheter replacements are predisposed to recurrent infections and thrombotic complications, which may limit the long-term survival of patients with SBS. Protocol-based CVC access procedures and daily care including taurolidine and ethanol catheter locks have been shown to reduce infection rates substantially. Compromised intestinal function in SBS predisposes to small bowel bacterial overgrowth, mucosal injury, and increased permeability. These pathophysiological changes are concentrated in a subset of patients with excessive bowel dilatation and frequent bowel-derived infections. In such patients, reconstructive intestinal surgery may be indicated. Probiotics have not been effective in infection prevention in SBS and carry a significant risk of complications. While more studies focusing on the prevention of infections and their complications are needed, protocol-based approach and multidisciplinary teams in the care of patients with SBS have been shown to reduce complications and improve outcomes.
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