J Pediatr Gastroenterol Nutr. 2022 Jan 18. doi: 10.1097/MPG.0000000000003382.Online ahead of print.

Jeremy S Stultz ¹, James H Fly, Bindiya Bagga, Sandra R Arnold, Anushree Algotar, Kelley R Lee

Author information

¹University of Tennessee Health Science Center Department of Clinical Pharmacy and Translational Science Le Bonheur Children's Hospital University of Tennessee Health Science Center College of Medicine Department of Pediatrics University of Tennessee Health Science Center College of Medicine Department of Pediatric Gastroenterology, Memphis, TN.

Abstract

Broader spectrum gram-negative antibiotics are commonly utilized empirically for central line-associated bloodstream infections (CLABSI) in febrile short bowel syndrome (SBS) patients receiving home parenteral nutrition compared to those used empirically for inpatient-acquired CLABSI. This analysis reports 57 CLABSI in 22 patients with SBS admitted from the community and 78 inpatient-acquired CLABSI in 76 patients over a 5-year period. Proportional gram-negative CLABSI was similar between the SBS and inpatient-acquired cohorts (43.8% versus 42.3%, respectively, p = 0.78). 1.8% and 10.3% (p = 0.125) of gram-negative CLABSI were non-susceptible to ceftriaxone and 0% and 3.8% (p = 0.52) were non-susceptible to ceftazidime in the SBS and inpatient-acquired cohorts, respectively. In the SBS cohort, home ethanol lock therapy and prior culture results impacted gram-negative pathogen distribution. Broader empiric gram-negative coverage for CLABSI among SBS patients compared to inpatients is unnecessary. Third-generation cephalosporins represent appropriate empiric gram-negative agents for febrile SBS patients presenting from the community to our institution.