Original Article Bishay M et al. Septicaemia Due to Enteric … Eur J Pediatr Surg received May 14, 2011 accepted after revision August 22, 2011 Bibliography DOI http://dx.doi.org/ 10.1055/s-0031-1287853 Published ahead of print Eur J Pediatr Surg © Georg Thieme Verlag KG Stuttgart · New York ISSN 0939-7248 Correspondence Prof. Agostino Pierro UCL Institute of Child Health Paediatric Surgery Unit London United Kingdom Tel.: +44 207 905 2641 Fax: +44 207 404 6181 a.pierro@ich.ucl.ac.uk Key words ● ▶ infection ● ▶ bacterial translocation ● ▶ neonatal intestinal obstruction ● ▶ necrotising enterocolitis ● ▶ gastroschisis Septicaemia Due to Enteric Organisms is a Later Event in Surgical Infants Requiring Parenteral Nutrition Patients/Material and Methods ▼ This was a single centre, retrospective, compara- tive cohort study. We studied 112 consecutive surgical infants (corrected gestational age up to 3 months at the start of PN) receiving PN for at least 5 days via a central venous catheter (CVC) for congenital or acquired intestinal anomalies, admitted under the care of general paediatric surgeons over a 2-year period (July 2007–June 2009). Ethical approval (08/H0713/31) for this study was obtained. Data collected included diagnosis, duration of PN, episodes of clinically suspected sepsis (defined as blood cultures taken), episodes of septicaemia (defined as growth of micro-organisms from blood culture), and organisms cultured. Informa- tion on the duration of PN was obtained from the pharmacy database, while data on blood cultures taken and results of culture were obtained from the pathology/microbiology database. Introduction ▼ Infants requiring gastrointestinal surgery and parenteral nutrition (PN) are at high risk of infec- tion [1–3]. Pierro et al. have shown that in surgi- cal neonates and infants who are receiving PN, septicaemia may be a gut-related phenomenon and this may be due to microbial translocation [2]. In addition, these authors [1] have shown that approximately half of this patient popula- tion develop abnormal gut flora which predis- poses to septicaemia. There has previously been some controversy in the literature as to whether infections in these infants are due to different causative organisms after different durations of parenteral nutrition [3–6]. The purpose of this study was to determine whether, in surgical infants requiring PN, septicaemia due to entero- cocci or Gram-negative bacilli occurs later than septicaemia due to coagulase-negative staphylo- cocci (CNS). Authors M. Bishay 1 , G. Retrosi 1 , V. Horn 2 , E. Cloutman-Green 3 , K. Harris 3 , P. de Coppi 1 , N. Klein 1 , S. Eaton 1 , A. Pierro 1 Affiliations Affiliation addresses are listed at the end of the article Abstract ▼ Introduction: The purpose of this study was to determine whether, in surgical infants requiring parenteral nutrition (PN), septicaemia due to enterococci or Gram-negative bacilli occurs later than septicaemia due to coagulase-negative sta- phylococci (CNS). Patients/Material and Methods: We retro- spectively studied 112 consecutive surgical infants (corrected gestational age up to 3 months) receiving PN for at least 5 days for congenital or acquired intestinal anomalies over a 2-year period (July 2007–June 2009). Data collected included diagnosis, duration of PN, episodes of septicaemia (defined as growth of bacteria from blood culture), and organisms cultured. We com- pared the time to first occurrence of septicaemia due to CNS with the times to first occurrence of septicaemia due to enterococci, Gram-negative bacilli, or other micro-organisms, using Kruskal- Wallis nonparametric ANOVA test and Dunn’s multiple comparisons test. Data are given as median (range). Results: 31 patients (28 %) had a total of 65 epi- sodes of septicaemia. Septicaemia due to CNS was most common, occurring in 22 % of patients, after 17 days (1–239) of PN. Septicaemia due to enteric organisms was less common and occurred significantly later, at 59 (24–103) days for entero- cocci (p < 0.01), and at 55 (30–106) days for Gram-negative bacilli (p < 0.05). Conclusions: Septicaemia due to enterococci or Gram-negative bacilli occurs later in the course of PN than septicaemia due to CNS, in surgical infants. This suggests that these infants become more vulnerable to the translocation of enteric micro-organisms after a longer period of parenteral nutrition. Downloaded by: University College of London. Copyrighted material.