Catheter sepsis in short-bowel syndrome
A. G. Kurkchubasche, S. D. Smith and M. I. Rowe
Department of Surgery, Children's Hospital of Pittsburgh, PA.
Catheter sepsis with catheter removal is an important problem in patients
with short-bowel syndrome. We determined the incidence of catheter sepsis
and the catheter salvage rate in 20 pediatric patients with short-bowel
syndrome. To evaluate the intestine as a source and translocation as the
pathophysiologic mechanism for catheter sepsis, we identified the sepsis
organisms, compared them with the fecal flora, and used mesenteric lymph
node cultures to document translocation. The incidence of catheter sepsis
was significantly higher in patients with short-bowel syndrome than in
patients without short-bowel syndrome (7.8 vs 1.3 per 1000 catheter days).
Overall catheter salvage was 42% and was highest in gram-negative sepsis
(71%). Enteric organisms were responsible for 62% of cases of catheter
sepsis in patients with short-bowel syndrome vs 12% in patients without
short-bowel syndrome. Anaerobes were strikingly absent in 25 of 28 stool
cultures. The sepsis organism was identified in the fecal flora in 19 of 28
cases. The dominant fecal organism or yeast was the septic organism in 12
of these 19 cases and was isolated in three of four mesenteric lymph node
cultures. Our findings support translocation as a mechanism in catheter
sepsis in patients with short-bowel syndrome.
