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Absence of bacteremia after gastrointestinal procedures in children
1Division of Pediatric Gastroenterology and Infectious Diseases, Children's Hospital of Michigan, Detroit, USA.
Insights
Clinically relevant bacteremia is rare in children after gastrointestinal endoscopy. This study found no significant infections, suggesting routine procedures with biopsies are safe for pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Infectious Diseases
- Endoscopy
Background:
- Bacteremia after gastrointestinal endoscopy is known in adults but understudied in children.
- Limited data exists on the frequency of bacteremia in pediatric patients undergoing endoscopic procedures.
Purpose of the Study:
- To prospectively determine the incidence of bacteremia following common gastrointestinal endoscopic procedures in pediatric patients.
- To assess the safety of routine endoscopic procedures, including biopsies, in children.
Main Methods:
- 108 endoscopies (EGDs, colonoscopies, sigmoidoscopies) were performed in 95 children (8 months–17 years).
- Blood cultures were obtained pre-procedure, post-procedure, and post-intubation (if applicable).
- Biopsy specimens were taken from all patients; cultures were analyzed for aerobic and anaerobic organisms.
Main Results:
- Four pre-endoscopic cultures were positive; two post-intubation cultures were positive but negative post-endoscopy.
- Four post-endoscopic cultures were positive, but all identified organisms were contaminants (skin/environmental flora).
- No patients with positive cultures showed symptoms of infection within 72 hours post-procedure.
Conclusions:
- Clinically significant bacteremia is infrequent after routine gastrointestinal endoscopic procedures with biopsies in immunocompetent children.
- The findings support the safety of these procedures in the pediatric population, with contaminants not leading to clinical infections.
Background:
Transient bacteremia after certain gastrointestinal endoscopies is well documented in adult patients; however, experience in pediatric patients is very limited. We conducted a prospective study to determine the frequency of bacteremia after common endoscopic procedures in children.
Methods:
A total of 108 endoscopies were performed in 95 patients (age range 8 months to 17 years; mean age 10.2 years). Procedures included 68 esophagogastroduodenoscopies (EGDs), 29 colonoscopies, and 11 flexible sigmoidoscopies. Most procedures (88) were performed with patients under conscious sedation; 20 were under general anesthesia with endotracheal intubation. Biopsy specimens were obtained from all patients. Blood samples for aerobic and anaerobic cultures were obtained prior to, and within 5 minutes of, completion of the procedure. In patients who underwent general anesthesia, a third sample was obtained 5 minutes after endotracheal intubation and before endoscopy.
Results:
Four of the pre-endoscopic blood cultures were positive. Two cultures were positive after endotracheal intubation, but were negative after endoscopy. Four cultures were positive after endoscopy. All organisms were skin or environmental flora and were considered contaminants. All patients with positive cultures remained asymptomatic during the 72 hours after the procedure.
Conclusion:
We conclude that clinically relevant bacteremia is very infrequent following routine endoscopic procedures with biopsies in immunocompetent children.