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496 Central Line-Associated Blood Stream Infections in Children with Short Bowel Syndrome

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Angel A. Herrera Guerra, MD , University of Utah Department of Pediatrics, Salt Lake City, UT
Emily A. Thorell, MD , University of Utah Department of Pediatrics, Salt Lake City, UT
Jared A. Olson, PharmD , Primary Children's Medical Center, Salt Lake City, UT
E. Kent Korgenski, MS , Intermountain Healthcare, Salt Lake City, UT
Andrew T. Pavia, MD , University of Utah Department of Pediatrics, Salt Lake City, UT
Background:

Central line-associated blood stream infections (CLABSI) are a major problem among children with short bowel syndrome (SBS).

Objective:

To describe the epidemiology and microbiology of CLABSI in children with SBS.

Methods:

We conducted a retrospective cohort study of CLABSI in patients with SBS. We identified children with SBS using the ICD 9 579.3 (other and unspecified postsurgical nonabsorption) evaluated at Primary Children’s Medical Center from January 1, 2004 to October 18, 2010. Patients were included in the cohort if they had a diagnosis of SBS and received parenteral nutrition for at least 30 days.  A CLABSI was defined as one positive blood culture for a pathogen (two from separate specimens for skin flora microorganisms) obtained from a central line. 

Results:

We identified 104 patients with SBS. Of these, 57 children (55%) experienced 235 episodes of CLABSI. The median number of CLABSI episodes in children with at least one infection was 2 (Range: 1-21).  Of these 235 episodes, 176 (75%) were monomicrobial and 59 (25 %) were polymicrobial with a median of 1 pathogen per infection (Range 1-4). Among the 59 polymicrobial infections two pathogens were isolated in 46 (78%), three in 10 (17%) and four (5%) in 3 of these cases.  Fifty five different species of microorganisms were isolated from 310 positive blood cultures. Gram positive cocci were most commonly isolated (152/235; 65%), followed by enteric Gram negatives (111/235; 47%) and yeast (41/235; 17%).  Staphylococcus epidermidis and other coagulase negative Staphylococci (n=76; 32%), Enterococcus faecalis (n=32; 14%), S. aureus (n=13, 6%) and Enterococcus faecium (n=11, 5%) were the most common Gram positive organisms. Escherichia coli (n=24, 10%) Enterobacter cloacae (n=23, 10%), Klebsiella oxytoca (n=19, 8%) and K. pneumoniae (n=16, 7%) were the most common Gram negative organisms. Yeasts included Candida albicans (n=15, 6%), C. glabrata (n=11, 5%) and C. parapsilosis (n=10, 4%). Non- albicans Candida accounted for 26 (63%) of the yeast isolates.

Conclusions:

CLABSI are common among children with SBS and are often polymicrobial. The majority of episodes are due to organisms typically associated with the GI tract; 40% are due to skin organisms. Strategies to prevent CLABSI in this high risk population are needed.