Remaining small bowel length: Association with catheter sepsis in patientsreceiving home total parenteral nutrition: Evidence of bacterial translocation

Patients with short bowel syndrome (SBS) receiving total parenteral nutriti on (TPN) have a high incidence of catheter-related sepsis, one of its major complications. The aim of this study was to correlate the length of remain ing small bowel (RSB) with septic episodes related to the central venous ca theter in a group of patients with severe SBS with home TPN. The length of the RSB (<50 cm or <greater than or equal to>50 cm) was related to the freq uency of catheter sepsis, time until the first episode, and the agents resp onsible in eight SBS patients receiving home TPN. There were 13 episodes of catheter infection (0.88 per patient-year). The group with a shorter RSB l ength (five patients) presented 1.3 to 2.76 infections/year and 2 to 9 mont hs until the first episode, compared to 0 to 0.75 infections/year (p = 0.03 57) and II to 65 months until the first episode (p = 0.0332) in the group w ith the longer RSB. In the first group, the agents isolated were Enterobact eriae (Enterobacter sp., Klebsiella sp., Pseudomonas sp., and Proteus sp.) in eight episodes and Candida sp. in one. In the latter sepsis was caused b y Staphylococcus sp. in three episodes and Pseudomonas sp. in one. Therefor e patients with remaining small bowel shorter than 50 cm have a higher freq uency of catheter-related sepsis, particularly by enteric microorganisms. T his might be an evidence of the occurrence of bacterial translocation and i ts role in the pathogenesis of catheter-related sepsis in patients with an extremely short RSB receiving home TPN.