Prevalence of Bloodstream Infections in Children with SBS and Fever

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;

This retrospective study with 246 encounters identified the rate of bloodstream infections (BSI) in children with short bowel syndrome (SBS).

Key findings:

  • 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.

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Don’t forget HLH

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