Risk Factors for Small Bowel Bacterial Overgrowth and Diagnostic Yield of Duodenal Aspirates in Children With Intestinal Failure: A Retrospective Review

J Pediatr Surg. 2012 Jun;47(6):1150-4. doi: 10.1016/j.jpedsurg.2012.03.019.

Abstract

Background: Children with intestinal failure (IF) are at risk for small bowel bacterial overgrowth (SBBO) because of anatomical and other factors. We sought to identify risk factors for SBBO confirmed by quantitative duodenal culture.

Methods: A single-center retrospective record review of children who had undergone endoscopic evaluation for SBBO (defined as bacterial growth in duodenal fluid of >10(5) colony-forming unit per mL) was performed.

Results: We reviewed 57 children with median (25th-75th percentile) age 5.0 (2.0-9.2) years. Diagnoses included motility disorders (28%), necrotizing enterocolitis (16%), atresias (16%), gastroschisis (14%), and Hirschsprung disease (10.5%). Forty patients (70%) had confirmed SBBO. Univariate analysis showed no significant differences between patients with and without SBBO for the following variables: age, sex, diagnosis, presence of ileocecal valve, and antacid use. Patients receiving parenteral nutrition (PN) were more likely to have SBBO (70% vs 35%, P = .02). Multiple logistic regression analysis confirmed that PN administration was independently associated with SBBO (adjusted odds ratio, 5.1; adjusted 95% confidence interval, 1.4-18.3; P = .01). SBBO was not related to subsequent risk of catheter-related bloodstream infection (CRBSI).

Conclusion: SBBO is strongly and independently associated with PN use. Larger prospective cohorts and more systematic sampling techniques are needed to better determine the relationship between SBBO and gastrointestinal function.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Antacids / therapeutic use
  • Bacteremia / epidemiology
  • Bacteremia / etiology
  • Bacteria / isolation & purification*
  • Bacterial Load
  • Catheter-Related Infections / epidemiology
  • Child
  • Child, Preschool
  • Duodenoscopy*
  • Duodenum / microbiology*
  • Enterocolitis, Necrotizing / complications
  • Enterocolitis, Necrotizing / microbiology
  • Female
  • Gastrointestinal Contents / microbiology*
  • Gastrointestinal Motility
  • Gastroschisis / complications
  • Gastroschisis / microbiology
  • Hirschsprung Disease / complications
  • Hirschsprung Disease / microbiology
  • Humans
  • Ileocecal Valve
  • Infant
  • Intestinal Atresia / complications
  • Intestinal Atresia / microbiology
  • Malabsorption Syndromes / diagnosis*
  • Malabsorption Syndromes / microbiology
  • Male
  • Parenteral Nutrition / adverse effects*
  • Retrospective Studies
  • Risk Factors
  • Short Bowel Syndrome / diagnosis
  • Short Bowel Syndrome / microbiology
  • Suction

Substances

  • Antacids