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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Central line-associated bloodstream infection among children with biliary atresia listed for liver transplantation
Nicole D Triggs, Stacey Beer, Sonam Mokha, Kat Hosek, Danielle Guffey, Charles G Minard, Flor M Munoz, Ryan W Himes
Nicole D Triggs, Stacey Beer, Ryan W Himes, Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, Houston, TX 77030, United States
Sonam Mokha, College of Arts and Sciences, Washington University in St. Louis, St. Louis, MO 63130, United States
Kat Hosek, Outcomes and Impact Service, Texas Children’s Hospital, Houston, TX 77030, United States
Danielle Guffey, Charles G Minard, Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX 77030, United States
Flor M Munoz, Department of Pediatrics, Section of Infectious Disease, Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Triggs ND, Beer S and Himes RW contributed to research design; Triggs ND, Beer S, Mokha S, Hosek K, Guffey D, Minard CG, Munoz FM and Himes RW contributed to acquisition and analysis of data, drafting and/or critical revision of manuscript; all authors approval of final version of manuscript.
Institutional review board statement: This study was approved by the Baylor College of Medicine Institutional Review Board and granted waiver of informed consent.
Informed consent statement: The Baylor College of Medicine Institutional Review Board granted waiver of informed consent for this project.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: 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. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ryan W Himes, MD, Assistant Professor, Department of Pediatrics, Section of Gastroenterology, Hepatology, and Nutrition, Baylor College of Medicine, 6701 Fannin St, MWT 1010, Houston, TX 77030, United States.
rwhimes@texaschildrens.org
Telephone: +1-832-8221050 Fax: +1-832-8253633
Received: November 14, 2018
Peer-review started: November 15, 2018
First decision: December 21, 2018
Revised: January 15, 2019
Accepted: January 26, 2019
Article in press: January 26, 2019
Published online: February 27, 2019
Processing time: 104 Days and 21.3 Hours
ARTICLE HIGHLIGHTS
Research background
Children with biliary atresia (BA) undergoing liver transplantation benefit from pre-operative optimization of their nutritional status. When feeding enterally is insufficient to rehabilitate these patients, parenteral nutrition (PN) may be a useful adjunct. While this modality has been shown to improve the growth of children with BA listed for liver transplantation, it is also associated with distinct risks, chief among them the risk of infection associated with an indwelling central venous catheter.
Research motivation
Our group was motivated to pursue this project so that the field might have a better understanding of the infectious risks of PN given to children with BA on the liver transplant waitlist, and thus make informed decisions regarding risk and benefit to the patient.
Research objectives
The objective of our study was to describe the incidence, microbiology, and risk factors of central line-associated bloodstream infection (CLABSI) among children with BA listed for liver transplantation.
Research methods
Retrospective, single-center review.
Research results
Nineteen of 63 patients (30%) experienced 29 episodes of CLABSI during 4800 line days (6.04 CLABSI per 1000 line days). CLABSI were 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. There were no demographic, laboratory, or clinical features associated with CLABSI risk in our model.
Research conclusions
CLABSI events are not rare among children with BA, receiving PN, while listed for liver transplantation. In spite of the frequency of events, CLABSI were not associated with mortality, or removal from the transplant waitlist due to becoming too ill to transplant. Since none of the factors tested in our model were associated with CLABSI risk, we propose meticulous application of known CLABSI-reducing strategies, such as line insertion bundles.
Research perspectives
Owing to the relatively small volume of pediatric liver transplants performed, even at the largest centers, future efforts should consider leveraging existing databases, such as Studies in Pediatric Liver Transplantation, to address these questions.
