The effects of intravenous epidermal growth factor on bacterial translocation and central venous catheter infection in the rat total parenteral nutrition model

Sepsis is a major complication of total parenteral nutrition (TPN) in child ren. Gut mucosal atrophy (GMA) and bacterial translocation (BT) occur in pa tients receiving TPN, and the translocated enteric organisms may cause cent ral venous catheter (CVC) infection. Epidermal growth factor (EGF) has a tr ophic effect on the gut mucosa and may reduce BT, thereby reducing catheter infection. Using a rat TPN model, the relationship between GMA, BT, and ca theter sepsis was examined and the effect on these of intravenous EGF was s tudied. There were four experimental groups. Group 1 had no CVC, Groups 2, 3, and 4 had a continuous central venous infusion as follows: group 2, sali ne; group 3, TPN; group 4, TPN with EGF. Groups 1 and 2 had free access to chow, groups 3 and 4 had no enteral feeds. After killing at 1 week, blood, tissue, and catheter specimens were cultured and mucosal morphology analyse d. BT was defined as the presence of the same organism in cultures from the gut lumen and mesenteric lymph nodes (MLN). TPN only (group 3) resulted in GMA and BT, and 5 of 12 animals with BT had the same gut bacteria in blood and/or catheter cultures. The addition of EGF to the TPN significantly red uced GMA, BT to the MLN, and blood and/or catheter infections (P = < 0.05). In animals carrying enterococci, there was a significant reduction in tran slocation of enterococci (group 3. 8/14; group 4. 0/11; P < 0.05) and cathe ter infection by enterococci was prevented (group 3. 3/14; group 4. 0/11). EGF thus reduced GMA, BT, and blood and/or catheter infection when given IV to rats receiving TPN. Enterococcal translocation and subsequent blood and /or catheter infection was completely prevented, suggesting a selective eff ect of EGF.