The Rate of Bloodstream Infection Is High in Infants with Short Bowel Syndrome: Relationship with Small Bowel Bacterial Overgrowth, Enteral Feeding, and Inflammatory and Immune Responses

• Published in: The Journal of pediatrics 2010-06, Vol.156 (6), p.941-947.e1
• Main Authors: Cole, Conrad R., MD, MPH, MSc, Frem, Juliana C., MD, Schmotzer, Brian, MS, Gewirtz, Andrew T., PhD, Meddings, Jonathan B., MD, Gold, Benjamin D., MD, Ziegler, Thomas R., MD
• Format: Article
• Language: English
• Subjects: Bacteria; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Children; Enteral Nutrition; Enterocolitis, Necrotizing - surgery; Feces - chemistry; Female; Flagellin - blood; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Human bacterial diseases; Humans; Incidence; Infant; Infectious diseases; Interleukin-1beta - blood; Interleukin-6 - blood; Interleukin-8 - blood; Intestine, Small - microbiology; Leukocyte L1 Antigen Complex - analysis; Male; Medical sciences; Other diseases. Semiology; Pediatrics; Pilot Projects; Sepsis - blood; Sepsis - epidemiology; Short Bowel Syndrome - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumor Necrosis Factor-alpha - blood
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2009.12.008

Objective This pilot study in parenteral nutrition–dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO), and systemic immune responses, as well as fecal calprotectin as a biomarker for SBBO. Study design Ten infants (ages 4.2-15.4 months) with SBS caused by necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin- and lipopolysaccharide-specific antibody titers, and proinflammatory cytokine concentrations (tumor necrosis factor–α [TNF-α], interleukin-1 β, -6, and -8) were performed at baseline and at 60 and 120 days. Healthy, age-matched control subjects (n = 5) were recruited. Results BSI incidence was high (80%), and SBBO was common (50%). SBBO increased the odds for BSI (>7-fold; P = .009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy control subjects ( P < .05). Serum TNF-α, was elevated at baseline versus controls. Serum TNF-α and interleukin-1 β, -6, and -8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-lipopolysaccharide immunoglobulin G levels in children with SBS were lower versus control subjects and rose over time. Conclusion In children with SBS, SBBO increases the risk for BSI, and systemic proinflammatory response decreases with increasing enteral feeding and weaning parenteral nutrition.