Risk Factors for Bloodstream Infection in Children with Intestinal Insufficiency on Parenteral Nutrition

Abstract

BackgroundBloodstream infection (BSI) is a major cause of morbidity and mortality in children with intestinal insufficiency, but studies defining risk factors are lacking. We aim to identify risk factors of BSI in children with intestinal insufficiency on parenteral nutrition (PN).MethodsRetrospective cohort study of children ≤ 18 years of age with intestinal insufficiency dependent on PN, who were followed at Lucile Packard Children’s Hospital (LPCH). The outcome of interest was rate of BSI. We studied proposed risk factors for BSI including sex, age, small intestine length at the time of surgery, diagnosis of short bowel syndrome (SBS), citrulline level (a marker of functioning enterocytes mass), central line (CL) days and CL breaks within 3 months. Data were represented in 6-monthintervals to study time dependent variables. Univariate analyses using t-test and regression analysis were conducted.ResultsRecords between 2014 and 2016 were reviewed identifying 43 children who met the inclusion criteria. The rate of infection was 3.39 per 1000 CL days. Younger age increased rate of BSI by 0.23/1000 CL days per year (95% confidence interval (CI): 0.14–0.32; P = 0.015) and shorter small bowel increased it by 0.27/1000 CL days for every 10-cm of small bowel (95% CI: 0.14–0.4; P = 0.045). Recent line breaks increased BSI rate by 3.47/1000 CL days (95% CI: 2.1–4.8; P = 0.014), and diagnosis of SBS increased it by 2.69/1000 CL days (95% CI: 2.02–3.36); P < 0.001). Rates of BSI increased by 0.33/1000 CL days for every 5 nmol/ml decrease in citrulline level, but this did not reach statistical significance (P = 0.059). We found no significant association between CVL days and the rate of BSI.ConclusionFactors associated with disturbance in intestinal integrity such as shorter small intestine and diagnosis with SBS are significant risk factors for BSI, highlighting the importance of intestinal translocation in its pathogenesis. Recent line breaks are important risk factor for BSI; an opportunity for prevention. BSI rates are higher in younger children likely due to immature bowel and/or difficult compliance with hygienic precautions handling CLs. No association was found between CL days and rate of BSI, which could guide the decision of CL removal vs. salvage.Disclosures All authors: No reported disclosures.