Yi Cao1, Wei-Hui Yan1, Li-Na Lu1, Yi-Jing Tao1, Hai-Xia Feng1, Qing-Qing Wu1, Yi-Jing Chu1, Wei Cai2,3,4, Ying Wang5. 1. Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd., Shanghai, China. 2. Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd., Shanghai, China. caiw204@sjtu.edu.cn. 3. Shanghai Institute for Pediatric Research, Shanghai, China. caiw204@sjtu.edu.cn. 4. Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, No. 1665, Kongjiang Rd., Shanghai, China. caiw204@sjtu.edu.cn. 5. Division of Pediatric Gastroenterology and Nutrition, Xinhua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665, Kongjiang Rd., Shanghai, China. wangying02@xinhuamed.com.cn.
Abstract
BACKGROUND: Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF. METHODS: This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China. Clinical data were collected, including data of temperature and gastrointestinal symptoms. Blood/catheter culture, fecal tests, and calculation of inflammatory index were performed, which were obtained within 1 week since CRBSI onset. RESULTS: Fifty children with 87 CRBSIs were identified, of which there were 17 suspected and 70 confirmed cases. Seventy-two pathogens were cultured from 70 positive blood cultures: 63% were Gram-positive organisms, 23% were Gram-negative organisms, and 11% were fungal organisms. Overall, 48.6% were enteric organisms; 47.2% of bacterial pathogens were consistent between fecal and blood cultures. Moreover, 46.3% fecal routines showed abnormalities including increased white blood cells, occult blood positive and the presence of fat droplets. The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output, abdominal distension, or both. C-reactive protein (CRP) and procalcitonin (PCT) were elevated, i.e., 16.5 mg/L [interquartile range (IQR) 8.7-44.7] and 0.48 ng/mL (IQR 0.2-1.76), respectively. CONCLUSIONS: IF children had a high rate of CRBSIs, of which larger proportions were due to Gram-positive and enteric organisms. Fever and/or gastrointestinal symptoms, combined with elevated CRP and PCT, is conducive to the early diagnosis of CRBSIs in IF patients.
BACKGROUND: Children with intestinal failure (IF) have frequent catheter-related bloodstream infections (CRBSIs). This study aimed to analyze the clinical presentation and laboratory parameters of CRBSIs in children with IF. METHODS: This 6-year retrospective study was conducted among IF children with CRBSIs at an intestinal rehabilitation center in China. Clinical data were collected, including data of temperature and gastrointestinal symptoms. Blood/catheter culture, fecal tests, and calculation of inflammatory index were performed, which were obtained within 1 week since CRBSI onset. RESULTS: Fifty children with 87 CRBSIs were identified, of which there were 17 suspected and 70 confirmed cases. Seventy-two pathogens were cultured from 70 positive blood cultures: 63% were Gram-positive organisms, 23% were Gram-negative organisms, and 11% were fungal organisms. Overall, 48.6% were enteric organisms; 47.2% of bacterial pathogens were consistent between fecal and blood cultures. Moreover, 46.3% fecal routines showed abnormalities including increased white blood cells, occult blood positive and the presence of fat droplets. The consistent symptom at onset of CRBSIs was fever and gastrointestinal symptoms including increased stool output, abdominal distension, or both. C-reactive protein (CRP) and procalcitonin (PCT) were elevated, i.e., 16.5 mg/L [interquartile range (IQR) 8.7-44.7] and 0.48 ng/mL (IQR 0.2-1.76), respectively. CONCLUSIONS: IF children had a high rate of CRBSIs, of which larger proportions were due to Gram-positive and enteric organisms. Fever and/or gastrointestinal symptoms, combined with elevated CRP and PCT, is conducive to the early diagnosis of CRBSIs in IF patients.
Authors: Siri Tribler; Christopher F Brandt; Anne H Petersen; Jørgen H Petersen; Kristian A Fuglsang; Michael Staun; Per Broebech; Claus E Moser; Palle B Jeppesen Journal: Am J Clin Nutr Date: 2017-08-09 Impact factor: 7.045
Authors: Riad Rahhal; Maisam A Abu-El-Haija; Lin Fei; Dawn Ebach; Sarah Orkin; Elizabeth Kiscaden; Conrad R Cole Journal: JPEN J Parenter Enteral Nutr Date: 2017-12-19 Impact factor: 4.016