Post-endoscopic fever and infection in paediatric patients with intestinal failure

Routine antimicrobial prophylaxis (AMP) for preventing bacteraemia and infection during paediatric gastrointestinal (GI) endoscopy is not recommended and is reserved for high-risk scenarios. However, in the unique group of children with intestinal failure (IF) and a central venous catheter (CVC), the incidence of post-endoscopic fever (PEF) and infection and the usefulness of AMP in protecting the indwelling catheter are unknown. This study evaluated fever and infection rates post-endoscopy, and the role of AMP in children with IF and CVC.

This retrospective single-centre observational study included children with IF and CVC who underwent GI endoscopy at our intestinal rehabilitation centre between 2019 and 2024. Owing to a policy change, routine AMP was terminated in 2022. AMP group (intravenous [i.v.] antibiotics) and no-AMP group (no i.v. AMP) were compared using chi-square and Mann-Whitney U tests.

A total of 233 endoscopies in 108 in-patients with IF and CVC were analysed: median age at endoscopy, 68 months (range: 1-206 months); female, 54.6%; short bowel syndrome, 73.1%. Intravenous AMP was used in 71.2% of the procedures. Median follow-up after endoscopy was 2 days. There were no differences between the AMP and no-AMP groups in terms of age, type of endoscopy, interventional procedures, or pre-endoscopic use of enteral antibiotics or proton-pump inhibitors. The overall PEF rate was 6%, with no significant difference between groups. No infections, including central line-associated bloodstream infections, were observed.

The frequency of PEF in children with IF is approximately 10 times higher than the recently reported incidence rate of 0.55% in paediatric patients. Since no bloodstream infections were confirmed, and AMP did not prevent PEF, routine administration of AMP for diagnostic endoscopy in children with IF is not indicated.