Post-endoscopic fever and infection in paediatric patients with intestinal failure.

Abstract

Objectives: Routine antimicrobial prophylaxis (AMP) for preventing bacteraemia and infection during paediatric gastrointestinal (GI) endoscopy is not recommended and is reserved for high-risk scenarios. However, in the unique group of children with intestinal failure (IF) and a central venous catheter (CVC), the incidence of post-endoscopic fever (PEF) and infection and the usefulness of AMP in protecting the indwelling catheter are unknown. This study evaluated fever and infection rates post-endoscopy, and the role of AMP in children with IF and CVC.

Methods: This retrospective single-centre observational study included children with IF and CVC who underwent GI endoscopy at our intestinal rehabilitation centre between 2019 and 2024. Owing to a policy change, routine AMP was terminated in 2022. AMP group (intravenous [i.v.] antibiotics) and no-AMP group (no i.v. AMP) were compared using chi-square and Mann-Whitney U tests.

Results: A total of 233 endoscopies in 108 in-patients with IF and CVC were analysed: median age at endoscopy, 68 months (range: 1-206 months); female, 54.6%; short bowel syndrome, 73.1%. Intravenous AMP was used in 71.2% of the procedures. Median follow-up after endoscopy was 2 days. There were no differences between the AMP and no-AMP groups in terms of age, type of endoscopy, interventional procedures, or pre-endoscopic use of enteral antibiotics or proton-pump inhibitors. The overall PEF rate was 6%, with no significant difference between groups. No infections, including central line-associated bloodstream infections, were observed.

Conclusions: The frequency of PEF in children with IF is approximately 10 times higher than the recently reported incidence rate of 0.55% in paediatric patients. Since no bloodstream infections were confirmed, and AMP did not prevent PEF, routine administration of AMP for diagnostic endoscopy in children with IF is not indicated.