The Journal of Pediatrics
Volume 156, Issue 6 , Pages 941-947.e1 , June 2010

The Rate of Bloodstream Infection Is High in Infants with Short Bowel Syndrome: Relationship with Small Bowel Bacterial Overgrowth, Enteral Feeding, and Inflammatory and Immune Responses

  • Conrad R. Cole, MD, MPH, MSc

      Affiliations

    • Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
    • Corresponding Author InformationReprint requests: Conrad R. Cole, MD, MPH, MSc, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta GA 30322.
    • ,
  • Juliana C. Frem, MD

      Affiliations

    • Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR
    • ,
  • Brian Schmotzer, MS

      Affiliations

    • Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
    • ,
  • Andrew T. Gewirtz, PhD

      Affiliations

    • Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
    • ,
  • Jonathan B. Meddings, MD

      Affiliations

    • Department of Medicine, University of Alberta, Edmonton, Canada
    • ,
  • Benjamin D. Gold, MD

      Affiliations

    • Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
    • ,
  • Thomas R. Ziegler, MD

      Affiliations

    • Department of Medicine, Emory University School of Medicine, Atlanta, GA

Received 7 May 2009 ,Revised 10 November 2009 ,Accepted 4 December 2009.

References 

  1. Schwartz MZ, Maeda K. Short bowel syndrome in infants and children. Pediatr Clin North Am. 1985;32:1265–1279
  2. Cole CR, Hansen NI, Higgins RD, Ziegler TR, Stoll BJ for the Eunice Kennedy Shriver Neonatal Research Network. Very low birth weight preterm infants with surgical short bowel syndrome: Incidence, morbidity and mortality, and growth outcomes at 18 to 22 months. Pediatrics. 2008;122:e573–e582
  3. Beau P, Barrioz T, Ingrand P. Total parenteral nutrition-related cholestatic hepatopathy, is it an infectious disease?. Gastroenterol Clin Biol. 1994;18:63–67
  4. Spencer AU, Kovacevich D, McKinney-Barnett M, Hair D, Canham J, Maksym C, et al. Pediatric short-bowel syndrome: the cost of comprehensive care. Am J Clin Nutr. 2008;88:1552–1559
  5. Terra RM, Plopper C, Waitzberg DL, Cukier C, Santoro S, Martins JR, 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
  6. Sondheimer JM, Asturias E, Cadnapaphornchai M. Infection and cholestasis in neonates with intestinal resection and long-term parenteral nutrition. J Pediatr Gastroenterol Nutr. 1998;27:131–137
  7. Kaufman SS, Loseke CA, Lupo JV, Young RJ, Murray ND, Pinch LW, et al. Influence of bacterial overgrowth and intestinal inflammation on duration of parenteral nutrition in children with short bowel syndrome. J Pediatr. 1997;131:356–361
  8. Shimizu K, Ogura H, Goto M, Asahara T, Nomoto K, Morotomi M, et al. Altered gut flora and environment in patients with severe SIRS. J Trauma. 2006;60:126–133
  9. Ziegler TR, Evans ME, Fernandez-Estivariz C, Jones DP. Trophic and cytoprotective nutrition for intestinal adaptation, mucosal repair, and barrier function. Annu Rev Nutr. 2003;23:229–261
  10. Gewirtz AT. Flag in the crossroads: flagellin modulates innate and adaptive immunity. Curr Opin Gastroenterol. 2006;22:8–12
  11. Ziegler TR, Luo M, Estivariz CF, Moore DA, Sitaraman SV, Hao L, et al. Detectable serum flagellin and lipopolysaccharide and upregulated anti-flagellin and lipopolysaccharide immunoglobulins in human short bowel syndrome. Am J Physiol Regul Integr Comp Physiol. 2008;294:R402–R410
  12. Gewirtz AT, Navas TA, Lyons S, Godowski PJ, Madara JL. Cutting edge: bacterial flagellin activates basolaterally expressed TLR5 to induce epithelial proinflammatory gene expression. J Immunol. 2001;167:1882–1885
  13. Bunn SK, Bisset WM, Main MJ, Gray ES, Olson S, Golden BE. Fecal calprotectin: validation as a noninvasive measure of bowel inflammation in childhood inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2001;33:14–22
  14. Fagerberg UL, Loof L, Myrdal U, Hansson LO, Finkel Y. Colorectal inflammation is well predicted by fecal calprotectin in children with gastrointestinal symptoms. J Pediatr Gastroenterol Nutr. 2005;40:450–455
  15. Diamond IR, de Silva N, Pencharz PB, Kim JH, Wales PW. Neonatal short bowel syndrome outcomes after the establishment of the first Canadian multidisciplinary intestinal rehabilitation program: preliminary experience. Journal of Pediatric Surgery. 2007;42:806–811
  16. Touloukian RJ, Smith GJ. Normal intestinal length in preterm infants. J. Pediatr Surg. 1983;18:720–723
  17. Gibson RS. Measuring food consumption of individuals. In: Principles of nutritional assessment. 2nd ed.. New York: Oxford University Press; 2005;p. 41–64
  18. de Boissieu D, Chaussain M, Badoual J, Raymond J, Dupont C. Small-bowel bacterial overgrowth in children with chronic diarrhea, abdominal pain, or both. J Pediatr. 1996;128:203–207
  19. Sigalet DL, Martin G, Meddings J, Hartman B, Holst JJ. GLP-2 levels in infants with intestinal dysfunction. Pediatr Res. 2004;56:371–376
  20. Ton H, Brandsnes , Dale S, Holtlund J, Skuibina E, Schjonsby H, et al. Improved assay for fecal calprotectin. Clin Chim Acta. 2000;292:41–54
  21. Perman JA, Modler S, Barr RG, Rosenthal P. Fasting breath hydrogen concentration: normal values and clinical applications. Gastroenterology. 1984;87:1358–1363
  22. Sigalet DL, Martin GR, Meddings JB. 3-0 methylglucose uptake as a marker of nutrient absorption and bowel length in pediatric patients. JPEN J Parenter Enteral Nutr. 2004;28:158–162
  23. Marsilio R, D'Antiga L, Zancan L, Dussini N, Zacchello F. Simultaneous HPLC determination with light-scattering detection of lactulose and mannitol in studies of intestinal permeability in pediatrics. Clinical Chemistry. 1998;44:1685–1691
  24. Cole CR, Ziegler TR. Small bowel bacterial overgrowth: a negative factor in gut adaptation in pediatric SBS. Curr Gastroenterol Rep. 2007;9:456–462
  25. Vanderhoof JA. New and emerging therapies for short bowel syndrome in children. J Pediatr Gastroenterol Nutr. 2004;39(Suppl 3):S769–S771
  26. Cole CR, Rising R, Lifshitz F. Consequences of incomplete carbohydrate absorption from fruit juice consumption in infants. Arch Pediatr Adolesc Med. 1999;153:1098–1102
  27. Corazza GR, Menozzi MG, Strocchi A, Rasciti L, Vaira D, Lecchini R, et al. The diagnosis of small bowel bacterial overgrowth. Reliability of jejunal culture and inadequacy of breath hydrogen testing. Gastroenterology. 1990;98:302–309
  28. O'Dwyer ST, Michie HM, Ziegler TR, Revhaug A, Smith RJ, Wilmore DW. A single dose of endotoxin alters intestinal permeability in healthy humans. Arch Surg. 1988;123:1459–1464
  29. Tian J, Hao L, Chandra P, Jones DP, Williams IR, Gewirtz AT, Ziegler TR. 2009 Dietary glutamine and oral antibiotics each improve indices of gut barrier function in rat short bowel syndrome. Am J Physiol 296:G348–G355.
  30. D'L , Dhawan A, Davenport M, Mieli-Vergani G, Bjarnason I. Intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study. J Pediatr Gastroenterol Nutr. 1999;29:588–593

 Supported in part by National Institutes of Health grants K12 RR017643 and KL2 RR025009 (to CRC), R01 DK55850 and K24 RR023356 (to T.Z.), UL1 RR025008 from the Clinical and Translational Science Award program and M01 RR0039 from the General Clinical Research Center program, National Center for Research Resources. The authors declare no conflicts of interest.

PII: S0022-3476(09)01236-0

doi: 10.1016/j.jpeds.2009.12.008

The Journal of Pediatrics
Volume 156, Issue 6 , Pages 941-947.e1 , June 2010

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