Christian Dohna Schwake1,2,3, Tamazoust Guiddir1, Gaelle Cuzon4, Mohamed-Rida Benissa5, Cécile Dubois1, Jordi Miatello1,6, Zied Merchaoui1, Philippe Durand1, Pierre Tissieres1,6. 1. Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France. 2. Pediatric Intensive Care, Universitätsmedizin Essen, Essen, Germany. 3. Westdeutsches Zentrum für Infektiologie, Universitätsmedizin Essen, Essen, Germany. 4. Laboratory of Microbiology, Paris South University Hospitals AP-HP, Le Kremlin-Bicêtre, France. 5. Pediatric Intensive Care Unit, University Hospitals of Geneva, Geneva, Switzerland. 6. Institute of Integrative Biology of the Cell, CNRS, CEA, Univ. Paris Sud, Paris Saclay University, Gif sur Yvette, France.
Abstract
BACKGROUND: Infectious complications after pediatric liver transplantation frequently occur and are potentially serious. Data concerning strictly defined bacterial infections and their associated risk factors are lacking. METHODS: For the pediatric liver transplant postoperative period, we analyzed data from the nosocomial infection surveillance (2006-2015). RESULTS: A total of 235 bacterial infections in 162 transplantations (47%) occurred, including 32 bacterial pneumonia cases, 104 surgical site infections, 27 urinary tract infections, and 40 bloodstream infections. Sepsis was diagnosed in 127 cases (54%), severe sepsis in 22 (9%) cases, and septic shock in 41 (17%) cases. Thirty patients (9%) died, and septic shock was the leading cause of death. The carrier status of multi-drug resistant bacteria and a tacrolimus level >20 ng/mL were independent risk factors for surgical site infections and the occurrence of severe sepsis or septic shock. The length of mechanical ventilation was an independent risk factor for pneumonia and surgical site infection. CONCLUSION: Bacterial infections in the early postoperative period after pediatric liver transplantation are associated with high morbidity and mortality. Physicians involved in the medical care of these patients should be aware of the specific risk factors, and further development of prevention programs is highly recommended.
BACKGROUND: Infectious complications after pediatric liver transplantation frequently occur and are potentially serious. Data concerning strictly defined bacterial infections and their associated risk factors are lacking. METHODS: For the pediatric liver transplant postoperative period, we analyzed data from the nosocomial infection surveillance (2006-2015). RESULTS: A total of 235 bacterial infections in 162 transplantations (47%) occurred, including 32 bacterial pneumonia cases, 104 surgical site infections, 27 urinary tract infections, and 40 bloodstream infections. Sepsis was diagnosed in 127 cases (54%), severe sepsis in 22 (9%) cases, and septic shock in 41 (17%) cases. Thirty patients (9%) died, and septic shock was the leading cause of death. The carrier status of multi-drug resistant bacteria and a tacrolimus level >20 ng/mL were independent risk factors for surgical site infections and the occurrence of severe sepsis or septic shock. The length of mechanical ventilation was an independent risk factor for pneumonia and surgical site infection. CONCLUSION:Bacterial infections in the early postoperative period after pediatric liver transplantation are associated with high morbidity and mortality. Physicians involved in the medical care of these patients should be aware of the specific risk factors, and further development of prevention programs is highly recommended.
Authors: Sonia Bianchini; Erika Rigotti; Sara Monaco; Laura Nicoletti; Cinzia Auriti; Elio Castagnola; Giorgio Conti; Luisa Galli; Mario Giuffrè; Stefania La Grutta; Laura Lancella; Andrea Lo Vecchio; Giuseppe Maglietta; Nicola Petrosillo; Carlo Pietrasanta; Nicola Principi; Simonetta Tesoro; Elisabetta Venturini; Giorgio Piacentini; Mario Lima; Annamaria Staiano; Susanna Esposito Journal: Antibiotics (Basel) Date: 2022-02-21