Cycled enteral antibiotics reduce sepsis rates in paediatric patients on long-term parenteral nutrition for intestinal failure

BACKGROUND

Long-term parenteral nutrition has transformed the prognosis for children suffering from intestinal failure. However, parenteral nutrition itself is associated with considerable morbidity and mortality including that caused by sepsis.

AIM

To examine a strategy of cycled enteral antibiotics in reducing the incidence of sepsis in paediatric intestinal failure patients.

METHODS

Retrospective analysis of the incidence of sepsis rates of patients on long-term parenteral nutrition, at a tertiary paediatric hospital. Patients were separated into those who received cycled enteral antibiotics and a control group. Sepsis rates before and during cycled enteral antibiotics were compared with comparable timeframes between the cycled enteral antibiotics and control groups. Central venous catheter removal rates were also compared.

RESULTS

Fifteen patients (eight cycled enteral antibiotics, & seven controls) received 9512 parenteral nutrition days, with a total of 132 sepsis episodes. All eight patients of the treatment group demonstrated a decrease in the frequency of episodes of sepsis following the introduction of cycled enteral antibiotics. The cycled enteral antibiotics group had a significant reduction in infection rate during the treatment period (from 2.14 to 1.06 per 100 parenteral nutrition days, P = 0.014: median effect size -1.04 CI 95%-1.93, -0.22), whereas the controls had no significant change (1.91 - 2.36 per 100 parenteral nutrition days P = 0.402: median effect size 0.92 CI 95%-1.96, 4.17). The central venous catheter survival rates increased in the cycled enteral antibiotics group from 0.44 central venous catheter removals per 100 parenteral nutrition days to 0.27 central venous catheter removals per 100 parenteral nutrition days, although this was not statistically significant.

CONCLUSIONS

Cycled enteral antibiotics significantly reduced the rate of sepsis in a small group of paediatric intestinal failure patients. Larger well-designed prospective studies are warranted to further explore this finding.

Drag force and surface roughness measurements on freshwater biofouled surfaces

The detrimental effect of biofilms on skin friction for near wall flows is well known. The diatom genera Gomphonema and Tabellaria dominated the biofilm mat in the freshwater open channels of the Tarraleah Hydropower Scheme in Tasmania, Australia. A multi-faceted approach was adopted to investigate the drag penalty for biofouled 1.0 m x 0.6 m test plates which incorporated species identification, drag measurement in a recirculating water tunnel and surface characterisation using close-range photogrammetry. Increases in total drag coefficient of up to 99% were measured over clean surface values for biofouled test plates incubated under flow conditions in a hydropower canal. The effective roughness of the biofouled surfaces was found to be larger than the physical roughness; the additional energy dissipation was caused in part by the vibration of the biofilms in three-dimensions under flow conditions. The data indicate that there was a roughly linear relationship between the maximum peak-to-valley height of a biofilm and the total drag coefficient.