Published online Feb 27, 2019. doi: 10.4254/wjh.v11.i2.208
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
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.
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.
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.
Retrospective, single-center review.
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.
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.
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.