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Infectious complications following serial transverse enteroplasty in infants and children with short bowel syndrome.
J Pediatr Surg. 2015 Mar; 50(3):428-30.JP

Abstract

BACKGROUND

Serial transverse enteroplasty (STEP) lengthens and tapers dilated small bowel in patients with short bowel syndrome (SBS). Previous reports document encouraging outcomes with regard to tolerance for enteral nutrition (EN) and complications appear related to the re-operative nature of many cases and to the presence of multiple staple lines. However, infectious complications following STEP have not been examined. Since infections, especially catheter-related blood stream infections (CRBSI), are considered detrimental in infants and children with SBS, we sought to define the frequency and outcomes of peri-operative infections associated with STEP.

METHODS

All children with SBS who underwent a STEP between 2004 and 2012 were indentified and their medical records were reviewed. Patients were considered candidates for a STEP if they had dilated small bowel and failure to advance enteral nutrition. For the purpose of this study, infections occurring within a 14-day period after STEP were considered procedure-related and were the focus of the study.

RESULTS

A total of 18 patients underwent 23 STEP procedures. Primary diagnoses included intestinal atresia, gastroschisis, necrotizing enterocolitis, and midgut volvulus. After the STEP, eight patients (35%) developed CRBSI, three developed wound infections, and two had urinary tract infections. Organisms isolated from either blood, wound or urine cultures included gram-positive cocci, gram-negative rods, and yeast. Perioperative antibiotics were administered in all cases with cefoxitin (43%) and piperacillin/tazobactam (30%) being most common. Neither antibiotic appeared superior in reducing the incidence of CRBSI. In three patients with persistent bacteremia despite adequate antibiotic therapy, a 74% ethanol lock resulted in negative blood cultures in all cases. Only one central venous catheter required replacement acutely for persistent fungemia.

CONCLUSION

STEP can improve enteral tolerance. In this fragile patient population, however, STEP carries a documented infectious burden. The optimal antibiotic prophylaxis and the role of ethanol locking in patients undergoing STEP require further study.

Authors+Show Affiliations

Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA.Division of Pediatric Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA; Section of Pediatric Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT 06520, USA. Electronic address: robert.cowles@yale.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25746702

Citation

Fujioka, Wendy K., and Robert A. Cowles. "Infectious Complications Following Serial Transverse Enteroplasty in Infants and Children With Short Bowel Syndrome." Journal of Pediatric Surgery, vol. 50, no. 3, 2015, pp. 428-30.
Fujioka WK, Cowles RA. Infectious complications following serial transverse enteroplasty in infants and children with short bowel syndrome. J Pediatr Surg. 2015;50(3):428-30.
Fujioka, W. K., & Cowles, R. A. (2015). Infectious complications following serial transverse enteroplasty in infants and children with short bowel syndrome. Journal of Pediatric Surgery, 50(3), 428-30. https://doi.org/10.1016/j.jpedsurg.2014.07.009
Fujioka WK, Cowles RA. Infectious Complications Following Serial Transverse Enteroplasty in Infants and Children With Short Bowel Syndrome. J Pediatr Surg. 2015;50(3):428-30. PubMed PMID: 25746702.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infectious complications following serial transverse enteroplasty in infants and children with short bowel syndrome. AU - Fujioka,Wendy K, AU - Cowles,Robert A, Y1 - 2014/08/27/ PY - 2014/02/05/received PY - 2014/06/19/revised PY - 2014/07/19/accepted PY - 2015/3/10/entrez PY - 2015/3/10/pubmed PY - 2016/1/1/medline KW - Bacteremia KW - Complication KW - Enteroplasty KW - Fungemia KW - Infection KW - Short bowel syndrome SP - 428 EP - 30 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 50 IS - 3 N2 - BACKGROUND: Serial transverse enteroplasty (STEP) lengthens and tapers dilated small bowel in patients with short bowel syndrome (SBS). Previous reports document encouraging outcomes with regard to tolerance for enteral nutrition (EN) and complications appear related to the re-operative nature of many cases and to the presence of multiple staple lines. However, infectious complications following STEP have not been examined. Since infections, especially catheter-related blood stream infections (CRBSI), are considered detrimental in infants and children with SBS, we sought to define the frequency and outcomes of peri-operative infections associated with STEP. METHODS: All children with SBS who underwent a STEP between 2004 and 2012 were indentified and their medical records were reviewed. Patients were considered candidates for a STEP if they had dilated small bowel and failure to advance enteral nutrition. For the purpose of this study, infections occurring within a 14-day period after STEP were considered procedure-related and were the focus of the study. RESULTS: A total of 18 patients underwent 23 STEP procedures. Primary diagnoses included intestinal atresia, gastroschisis, necrotizing enterocolitis, and midgut volvulus. After the STEP, eight patients (35%) developed CRBSI, three developed wound infections, and two had urinary tract infections. Organisms isolated from either blood, wound or urine cultures included gram-positive cocci, gram-negative rods, and yeast. Perioperative antibiotics were administered in all cases with cefoxitin (43%) and piperacillin/tazobactam (30%) being most common. Neither antibiotic appeared superior in reducing the incidence of CRBSI. In three patients with persistent bacteremia despite adequate antibiotic therapy, a 74% ethanol lock resulted in negative blood cultures in all cases. Only one central venous catheter required replacement acutely for persistent fungemia. CONCLUSION: STEP can improve enteral tolerance. In this fragile patient population, however, STEP carries a documented infectious burden. The optimal antibiotic prophylaxis and the role of ethanol locking in patients undergoing STEP require further study. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/25746702/Infectious_complications_following_serial_transverse_enteroplasty_in_infants_and_children_with_short_bowel_syndrome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(14)00468-0 DB - PRIME DP - Unbound Medicine ER -