Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jan;70(1):59-63.
doi: 10.1097/MPG.0000000000002506.

Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients

Bram P Raphael  1 , Greg Fournier  1 , Sarah R McLaughlin  2 , Mark Puder  3 , Sarah Jones  4 , Kelly B Flett  4
Affiliations

Antibiotic Susceptibility and Therapy in Central Line Infections in Pediatric Home Parenteral Nutrition Patients

Bram P Raphael et al. J Pediatr Gastroenterol Nutr. 2020 Jan.

Abstract

Background: Patients receiving home parenteral nutrition (HPN) are at high-risk for central line-associated bloodstream infections (CLABSI). There are no published management guidelines, however, for the antibiotic treatment of suspected CLABSI in this population. Historical microbiology data may help inform empiric antimicrobial regimens in this population.

Objective: The aim of the study was to describe antimicrobial resistance patterns and determine the most appropriate empiric antibiotic therapy in HPN-dependent children experiencing a community-acquired CLABSI.

Methods: Single-center retrospective cohort study evaluating potential coverage of empiric antibiotic regimens in children on HPN who developed a community-acquired CLABSI.

Results: From October 1, 2011 to September 30, 2017, there were 309 CLABSI episodes among 90 HPN-dependent children with median age 3.8 years old.Fifty-nine percent of patients carried the diagnosis of surgical short bowel syndrome. Organisms isolated during these infections included 60% Gram-positive bacteria, 34% Gram-negative bacteria, and 6% fungi. Among all staphylococcal isolates, 51% were methicillin sensitive. Among enteric Gram-negative organisms, sensitivities were piperacillin-tazobactam 71%, cefepime 97%, and meropenem 99%. Organisms were sensitive to current institutional standard therapy with vancomycin and piperacillin-tazobactam in 69% of cases compared with vancomycin and cefepime or vancomycin an meropenem in 85% and 96% of cases (both P < 0.01).

Conclusions: Empiric antimicrobial therapy for suspected CLABSI in HPN-dependent children should include therapy for methicillin-resistant staphylococci as well as enteric Gram-negative organisms. Future studies are needed to evaluate clinical outcomes based upon evidence-based antimicrobial regimens.

PubMed Disclaimer

References

    1. Winkler MF, DiMaria-Ghalili RA, Guenter P, et al. Characteristics of a cohort of home parenteral nutrition patients at the time of enrollment in the Sustain Registry. JPEN J Parenter Enteral Nutr 2016; 40:1140–1149.
    1. Squires RH, Duggan C, Teitelbaum DH, et al. Pediatric Intestinal Failure Consortium. Natural history of pediatric intestinal failure: initial report from the Pediatric Intestinal Failure Consortium. J Pediatr 2012; 161:723.e2–728.e2.
    1. Spencer AU, Kovacevich D, McKinney-Barnett M, et al. Pediatric short-bowel syndrome: the cost of comprehensive care. Am J Clin Nutr 2008; 88:1552–1559.
    1. Terra RM, Plopper C, Waitzberg DL, et al. Remaining small bowel length: association with catheter sepsis in patients receiving home total parenteral nutrition: evidence of bacterial translocation. World J Surg 2000; 24:1537–1541.
    1. Kurkchubasche AG, Smith SD, Rowe MI. Catheter sepsis in short-bowel syndrome. Arch Surg 1992; 127:21–24.

Publication types

Substances