title: 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.
abstract: OBJECTIVE
  This pilot study in parenteral nutrition-dependent infants with short bowel syndrome (SBS) evaluated the impact of feeding route and intestinal permeability on bloodstream infection (BSI), small bowel bacterial overgrowth (SBBO), and systemic immune responses, as well as fecal calprotectin as a biomarker for SBBO.
  
  
  METHODS
  Ten infants (ages 4.2-15.4 months) with SBS caused by necrotizing enterocolitis were evaluated. Nutritional assessment, breath hydrogen testing, intestinal permeability, fecal calprotectin, serum flagellin- and lipopolysaccharide-specific antibody titers, and proinflammatory cytokine concentrations (tumor necrosis factor-alpha [TNF-alpha], interleukin-1 beta, -6, and -8) were performed at baseline and at 60 and 120 days. Healthy, age-matched control subjects (n = 5) were recruited.
  
  
  RESULTS
  BSI incidence was high (80%), and SBBO was common (50%). SBBO increased the odds for BSI (>7-fold; P = .009). Calprotectin levels were higher in children with SBS and SBBO versus those without SBBO and healthy control subjects (P < .05). Serum TNF-alpha, was elevated at baseline versus controls. Serum TNF-alpha and interleukin-1 beta, -6, and -8 levels diminished with increased enteral nutrition. Anti-flagellin and anti-lipopolysaccharide immunoglobulin G levels in children with SBS were lower versus control subjects and rose over time.
  
  
  CONCLUSIONS
  In children with SBS, SBBO increases the risk for BSI, and systemic proinflammatory response decreases with increasing enteral feeding and weaning parenteral nutrition.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. Electronic address: crcole@emory.edu.
authors.forename: Conrad R
authors.initials: CR
authors.lastname: Cole
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR.
authors.forename: Juliana C
authors.initials: JC
authors.lastname: Frem
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Brian
authors.initials: B
authors.lastname: Schmotzer
authors.affiliation: Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gewirtz
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Canada.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Meddings
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Gold
authors.affiliation: Department of Medicine, Emory University School of Medicine, Atlanta, GA.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
mesh_terms: D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000601:surgery; D005243:Feces / Q000737:chemistry; D005260:Female; D005408:Flagellin / Q000097:blood; D006801:Humans; D015994:Incidence; D007223:Infant; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007421:Intestine, Small / Q000382:microbiology*; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis; D008297:Male; D010865:Pilot Projects; D018805:Sepsis / Q000097:blood* / Q000453:epidemiology; D012778:Short Bowel Syndrome / Q000453:epidemiology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D053583:Interleukin-1beta; D015850:Interleukin-6; D016209:Interleukin-8; D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D005408:Flagellin