Cargando…

Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation

BACKGROUND: Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been show...

Descripción completa

Detalles Bibliográficos
Autores principales: Triggs, Nicole D, Beer, Stacey, Mokha, Sonam, Hosek, Kat, Guffey, Danielle, Minard, Charles G, Munoz, Flor M, Himes, Ryan W
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393719/
https://www.ncbi.nlm.nih.gov/pubmed/30820270
http://dx.doi.org/10.4254/wjh.v11.i2.208
_version_ 1783398747465580544
author Triggs, Nicole D
Beer, Stacey
Mokha, Sonam
Hosek, Kat
Guffey, Danielle
Minard, Charles G
Munoz, Flor M
Himes, Ryan W
author_facet Triggs, Nicole D
Beer, Stacey
Mokha, Sonam
Hosek, Kat
Guffey, Danielle
Minard, Charles G
Munoz, Flor M
Himes, Ryan W
author_sort Triggs, Nicole D
collection PubMed
description BACKGROUND: Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation, less is known about the risks, particularly infectious, associated with this therapy among this specific group of patients. AIM: To describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation. METHODS: Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children’s Hospital from 2008 through 2015 (n = 96). Patients with a central line for administration of PN (n = 63) were identified and details of each CLABSI event were abstracted. We compared the group of patients who experienced CLABSI to the group who did not, to determine whether demographic, clinical, or laboratory factors correlated with development of CLABSI. RESULTS: Nineteen of 63 patients (30%, 95%CI: 19, 43) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI was predominantly associated with Gram-negative organisms (14/29 episodes, 48%) including Klebsiella spp., Enterobacter spp., and Escherichia coli. The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae. Gram-positive organisms (all Staphylococcus spp.) and fungus (all Candida spp.) comprised 9/29 (31%) and 6/29 (21%) episodes, respectively. No demographic, clinical, or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION: There is substantial risk for CLABSI among children with BA listed for liver transplantation. No clinical, demographic, or laboratory factor we tested emerged as an independent predictor of CLABSI. While our data did not show an impact of CLABSI on the short-term clinical outcome, it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization, unnecessary healthcare dollar expenditures, and may exact an opportunity cost, in terms of missed allograft offers.
format Online
Article
Text
id pubmed-6393719
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-63937192019-02-28 Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation Triggs, Nicole D Beer, Stacey Mokha, Sonam Hosek, Kat Guffey, Danielle Minard, Charles G Munoz, Flor M Himes, Ryan W World J Hepatol Retrospective Study BACKGROUND: Pre-transplant nutrition is a key driver of outcomes following liver transplantation in children. Patients with biliary atresia (BA) may have difficulty achieving satisfactory weight gain with enteral nutrition alone, and parenteral nutrition (PN) may be indicated. While PN has been shown to improve anthropometric parameters of children with BA listed for liver transplantation, less is known about the risks, particularly infectious, associated with this therapy among this specific group of patients. AIM: To describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation. METHODS: Retrospective review of children aged ≤ 2-years of age with BA who were listed for primary liver transplantation at Texas Children’s Hospital from 2008 through 2015 (n = 96). Patients with a central line for administration of PN (n = 63) were identified and details of each CLABSI event were abstracted. We compared the group of patients who experienced CLABSI to the group who did not, to determine whether demographic, clinical, or laboratory factors correlated with development of CLABSI. RESULTS: Nineteen of 63 patients (30%, 95%CI: 19, 43) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI was predominantly associated with Gram-negative organisms (14/29 episodes, 48%) including Klebsiella spp., Enterobacter spp., and Escherichia coli. The sole polymicrobial infection grew Enterobacter cloacae and Klebsiella pneumoniae. Gram-positive organisms (all Staphylococcus spp.) and fungus (all Candida spp.) comprised 9/29 (31%) and 6/29 (21%) episodes, respectively. No demographic, clinical, or laboratory factors were significantly associated with an increased risk for the first CLABSI event in Cox proportional hazards regression analysis CONCLUSION: There is substantial risk for CLABSI among children with BA listed for liver transplantation. No clinical, demographic, or laboratory factor we tested emerged as an independent predictor of CLABSI. While our data did not show an impact of CLABSI on the short-term clinical outcome, it would seem prudent to implement CLABSI reduction strategies in this population to the extent that each CLABSI event represents potentially preventable hospitalization, unnecessary healthcare dollar expenditures, and may exact an opportunity cost, in terms of missed allograft offers. Baishideng Publishing Group Inc 2019-02-27 2019-02-27 /pmc/articles/PMC6393719/ /pubmed/30820270 http://dx.doi.org/10.4254/wjh.v11.i2.208 Text en ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Triggs, Nicole D
Beer, Stacey
Mokha, Sonam
Hosek, Kat
Guffey, Danielle
Minard, Charles G
Munoz, Flor M
Himes, Ryan W
Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title_full Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title_fullStr Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title_full_unstemmed Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title_short Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
title_sort central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393719/
https://www.ncbi.nlm.nih.gov/pubmed/30820270
http://dx.doi.org/10.4254/wjh.v11.i2.208
work_keys_str_mv AT triggsnicoled centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT beerstacey centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT mokhasonam centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT hosekkat centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT guffeydanielle centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT minardcharlesg centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT munozflorm centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation
AT himesryanw centrallineassociatedbloodstreaminfectionamongchildrenwithbiliaryatresialistedforlivertransplantation