Abstract Link: Prevalence of Bloodstream Infections in Children With Short‐Bowel Syndrome With a Central Line Presenting to Emergency Department With Fever
AC Fifi et al JPEN; https://doi.org/10.1002/jpen.1701
This retrospective study with 246 encounters identified the rate of bloodstream infections (BSI) in children with short bowel syndrome (SBS).
- The adjusted calculated prevalence rate for BSI in children with SBS and fever was 55% (95% CI, 42.3%–65.4%)
- There were 114 gram‐negative infections (72.6%), 46 gram‐positive infections (29.3%), and 17 fungal infections (10.8%)
- Each additional 10 units above 20 mg/L CRP increased the odds of BSI by 26%. There was no association between WBC count and the presence of BSI
My take: This study supports the practice of using broad‐spectrum antibiotics in children with SBS and fever.
Related blog posts:
Atlanta Botanical Garden
A recent clinical challenge (Gastroenterol 2013; 145: 289, 489) regarding a a 78-year-old with a 12-year history of ulcerative colitis serves as a good reminder to remember hemophagocytic lymphohistiocytosis (HLH) in inflammatory bowel disease patients with high fever, even in the presence of recognized viral infections like cytomegalovirus and Epstein-Barr virus which can trigger HLH. Patients receiving immunosuppressive medications are at risk.
Other clinical points:
- Consider HLH when cytopenias are present in addition to fever
- Ferritin values >10,000 mcg/L serves as a good screen
Take-home point: HLH has a significant mortality rate. Quick recognition can improve outcome.
Related blog post:
Diagnosing hemophagocytic lymphohistiocytosis … – gutsandgrowth