title: Increased Anti-Flagellin and Anti-Lipopolysaccharide Immunoglobulins in Pediatric Intestinal Failure: Associations With Fever and Central Line-Associated Bloodstream Infections.
abstract: BACKGROUND
  Central line-associated bloodstream infections (CLABSIs) pose a significant challenge in the lives of patients with intestinal failure (IF). We hypothesized that plasma immunoglobulins against flagellin (FLiC) and lipopolysaccharide (LPS) would be able to differentiate CLABSIs from nonbacterial febrile episodes and that levels would increase with infection and decline following appropriate antibiotic treatment.
  
  
  METHODS
  Patients with IF, due to short bowel syndrome, between the ages of 3 months and 4 years of age, were recruited at Cincinnati Children's Hospital Medical Center. Anti-FLiC and anti-LPS plasma antibody levels were measured in 13 children with IF at baseline, during febrile events, and also following treatment with antibiotics. These were also measured in 11 healthy children without IF who were recruited as controls.
  
  
  RESULTS
  Plasma anti-FLiC IgA levels increased during febrile episodes in all patients with IF (baseline mean of 1.10 vs febrile episode mean of 1.32 optical density units, respectively; P = .046). Neither plasma anti-FLiC nor anti-LPS IgA or IgG levels distinguished CLABSI from nonbacterial febrile episodes compared with baseline levels. Compared with controls, patients with IF had significantly higher plasma levels of anti-FLiC and anti-LPS IgA at baseline.
  
  
  CONCLUSIONS
  Plasma anti-FLiC IgA antibody levels rise during febrile episodes but do not differentiate between nonbacterial febrile illnesses and CLABSIs in pediatric IF. However, the upregulation of these antibodies in IF suggests the baseline systemic presence of Gram-negative bacterial products.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio David.galloway@cchmc.org.
authors.forename: David P
authors.initials: DP
authors.lastname: Galloway
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Misty L
authors.initials: ML
authors.lastname: Troutt
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kocoshis
authors.affiliation: Center for Inflammation, Immunity, and Infection, Department of Biology, Georgia State University, Atlanta, Georgia.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Gewirtz
authors.affiliation: Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, Atlanta, Georgia.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Ziegler
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Conrad R
authors.initials: CR
authors.lastname: Cole
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000097:blood*; D015415:Biomarkers; D055499:Catheter-Related Infections / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D002405:Catheterization, Central Venous; D057785:Catheters; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology; D005408:Flagellin / Q000276:immunology*; D006090:Gram-Negative Bacteria; D006801:Humans; D007223:Infant; D007422:Intestines / Q000382:microbiology / Q000473:pathology; D008070:Lipopolysaccharides / Q000276:immunology*; D008297:Male; D009820:Ohio; D012778:Short Bowel Syndrome / Q000150:complications* / Q000276:immunology / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000888:Antibodies, Anti-Idiotypic; D015415:Biomarkers; D008070:Lipopolysaccharides; C049937:anti-IgA; D005408:Flagellin
keywords: bacterial infection; biomarker; fever; parenteral nutrition; short bowel syndrome