Methods: Retrospective cohort study of children ≤ 18 years with IF dependent on parenteral nutrition (PN), with ≥1 BSI from January 2007 to December 2016. Organisms causing BSI were divided into skin or GI bacteria and fungi based on human habitat and kingdom. The impact of ethanol lock therapy (ELT) and clinical diagnosis of small intestine bacterial overgrowth (SIBO) on the type of these organisms was evaluated. Antimicrobial utilization and outcome measures for BSI were collected.
Results: There were 254 BSIs in 54 children resulting from GI bacteria (58%), skin bacteria (39%), and fungi (16%) with 11% containing > 1 group. The proportion of skin bacteria was significantly higher on ELT (27% off vs 45% on ELT; P=0.003), while the proportion of GI bacteria was lower (67% off vs 52% on ELT; P=0.018). Significantly more fungal BSIs were seen in older children: mean age 4.2 years (95% CI: 2.9-5.5) vs 2.7 years (95% CI: 2.3-3) with other organisms; P=0.014. Fungal BSIs were more common with SIBO (18% vs 5% with and without SIBO; P=0.013). 28 organisms were resistant to ceftazidime, and 5 to cefepime. Hospitalization days totaled 2432 (median 8 days), with 21 pediatric critical care admissions totaling 156 days. There were 6 deaths, none related to BSI, 18/54 children were weaned off PN, and 4 had liver and intestinal transplants. Median course of antimicrobial therapy was 14 days.
Conclusion: The majority BSIs in children resulted from GI bacteria, suggesting intestinal translocation; these infections were not less common in older children despite increased intestinal mass, signifying continued translocation. BSI with GI organisms was not more common in children with SIBO despite increased intestinal bacterial load, possibly due to antibiotic suppressive therapy, which instead lead to more fungal BSIs. Prevention of BSI by ELT was less effective for skin bacteria which may require different regimens or strategies. BSI causes frequent and prolonged hospitalizations including need for intensive care, but deaths are rare.
C. Nespor, None
J. Kerner, None
H. A. Gans, None