Increased Anti-Flagellin and Anti-Lipopolysaccharide Immunoglobulins in Pediatric Intestinal Failure: Associations With Fever and Central Line-Associated Bloodstream Infections

• Type of Material: Article
• Authors: David P. Galloway, Cincinnati Children's Hospital Medical Center; Misty L. Troutt, Cincinnati Children's Hospital Medical Center; Samuel A. Kocoshis, Cincinnati Children's Hospital Medical Center; Andrew T Gewirtz, Emory University; Thomas R Ziegler, Emory University; Conrad R. Cole, Cincinnati Children's Hospital Medical Center
• Language: English
• Date: 2015-07-01
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 American Society for Parenteral and Enteral Nutrition.
• Final Published Version (URL): http://dx.doi.org/10.1177/0148607114537073
• Title of Journal or Parent Work: Journal of Parenteral and Enteral Nutrition
• ISSN: 0148-6071
• Volume: 39
• Issue: 5
• Start Page: 562
• End Page: 568
• Grant/Funding Information: This study is funded in part by training grant T32 DK 07727 in Pediatric Gastroenterology and Nutrition (D.P.G.); and grants 1R21DK088027-01A1 (C.R.C.) and K24 DK096574 (T.R.Z.) from the National Institutes of Health.
• Keywords: biomarker; parenteral nutrition; Nutrition & Dietetics; LIPOPOLYSACCHARIDE-BINDING PROTEIN; TRANSLOCATION; Life Sciences & Biomedicine; LOCKS; bacterial infection; INFANTS; MARKER; Science & Technology; short bowel syndrome; fever
• Research Categories: Health Sciences, Pathology; Health Sciences, Medicine and Surgery

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. Materials and 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. Conclusion: 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.