Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Pouladfar, Gholamreza; Jafarpour, Zahra; Malek-Hosseini, Seyed Ali; Firoozifar, Mohammad; Rasekh, Razieh; Khosravifard, Leila

doi:10.1111/tid.13001

Cited by 19 publications

(23 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this one-year, retrospective study, an incidence of 67.9% infection rate was observed, which was higher than a previous study in Iran, reporting an incidence of 54.3% bacterial infection among liver transplant pediatrics. [17]. Our ndings are also in accordance with the limited reports worldwide regarding LT in pediatrics (51.9% in Germany and 70.8% in France).…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, multivariate regression analysis showed that the only risk factor for bacterial infections after LT in pediatrics is the length of stay in the ICU. Factors such as a longer hospitalization and longer stay in ICU have been formerly described to be linked with increased infection in LT by other authors [17,34,35]. Although our study revealed that the tacrolimus level was higher in the infected group compared to the non-infected group, no statistical signi cance was observed.…”

Section: Discussioncontrasting

confidence: 73%

“…In the case of gram-positive pathogens, the incidence of VRE infections has been reported to be about 31% in our study, while in the study of Pouladfar et al, 82% of Enterococcus species were VRE [17]. The reasons for this difference in the incidence of VRE can be attributed to the establishment and implementation of stewardship antibiotic programs in our hospital under the supervision of infectious disease and clinical pharmacist specialists in recent years, which has led to a dramatic reduction in the use of inappropriate broad-spectrum antibiotics such as vancomycin.…”

Section: Discussioncontrasting

confidence: 55%

See 2 more Smart Citations

Bacterial Infections after Pediatric Liver Transplantation

Shafiekhani

Shahriarirad

parandvar

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Liver transplantation (LT) is the only curative therapy for acute and chronic end-stage liver disease in pediatrics. Nevertheless, bacterial infection post-transplant account for one of the most significant causes of mortality which requires attention, along with appropriate antibacterial treatment. Therefor this study was designed to provide a multifaceted overview of bacterial infections during a one-year experience in the biggest pediatrics LT center in Iran.Methods: In this retrospective cohort study, records from all liver transplant pediatrics in Abu-Ali Sina hospital, Shiraz, Fars, Iran from April 2019 to February 2020 were assessed. Demographic, laboratory, and clinical data were extracted along with the administered therapeutic approach for the patient.Results: an incidence of 67.9% bacterial infection rate was observed, in which more than 64.06% of isolated pathogens were Gram-negative and 35.93% were gram-positive. The most isolated pathogens were E. coli sp. and pseudomonas sp. for gram negative, and enterococci and staph sp. for gram positive. Our study demonstrated that Intra-abdominal Surgical Site Infections (24.24%) was the most common site of infections in post LT pediatrics. According to the results of the sensitivity-resistance pattern of isolated pathogens, 24.39% of isolated gram-negative bacteria were Extensively drug resistant (XDR). Also, 30.43% of gram-positive bacteria were Vancomycin-resistant enterococci (VRE) and 8.69% of them were methicillin-resistant staphylococcus aureus (MRSA). Furthermore, multivariate regression analysis showed that the only risk factor for bacterial infections after LT is the length of stay in the ICU. The mortality rate in our study was 22%, which was significantly higher among the infection group (P = 0.008). Also, it was found that patients receiving colistin had a significantly shorter in length of stay in the ICU and hospital than those who did not receive colistin. There is no any significant difference between piperacillin-tazobactm versus meropenem as empirical treatment regarding clinical outcomes.Conclusion: a high rate of bacterial infection was detected among hospitalized pediatrics in the early period after LT. High antibacterial resistance of bacteria isolated from LT pediatrics is alarming. Furthermore, Replacement of piperacillin-tazobactam instead of carbapenems in empirical treatment should be considered.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 73%

Section: Discussioncontrasting

confidence: 55%

See 1 more Smart Citation

Bacterial Infections after Pediatric Liver Transplantation

Shafiekhani

Shahriarirad

parandvar

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Liver transplantation (LT), which requires a major surgical procedure, serves as the standard treatment for terminal stage hepatic conditions 1,2 . In general, infection and rejection are the most important complications and the main causes of mortality and morbidity after LT 3,4 . Although such infections could occur at any time after LT, their incidence is highest in the early post ‐LT period.…”

Section: Introductionmentioning

confidence: 99%

“…These infections are typically associated with surgical and perioperative complications, use of invasive devices, nosocomial infections, and immunosuppression 2,5,6 . Bacterial pathogens are reportedly the most frequent causes of infection during the period 2,3,5 . Assessment of risk factors can aid in the early identification of infections and can be used to develop a scoring system for the prediction of infections in LT patients.…”

Section: Introductionmentioning

confidence: 99%

Bacterial infections in the early period after liver transplantation in adults: A prospective single‐center cohort study

Jafarpour

Pouladfar

Malek-Hosseini

et al. 2020

Microbiology and Immunology

Self Cite

View full text Add to dashboard Cite

Liver transplantation (LT) is a potentially curative treatment for terminal stage hepatic diseases. Bacterial infections are the main causes of mortality and morbidity in the early period after LT. Identifying the risk factors could help in minimizing their development. We prospectively investigated the incidence, characteristics, and risk factors of bacterial infections among the recipients during hospitalization after LT and assigned a predictive score. All 389 consecutive adults who underwent LT at the main referral hospital of LT in Iran during 1 year were enrolled prospectively in a cohort study. Infection group consisted of 143 recipients (36.8%). Urinary tract and surgical site infections were the most frequent ones. Gram-negative bacteria were more prevalent than Gram-positive ones. Independent risk factors were female sex (relative risks = 2.13), age ≤ 43.5 years (3.70), hospital stay ≥ 9.5 days (5.22), abdominal reoperation (3.03), vancomycin-resistant Enterococci colonization (5.52), hospitalization 3 months prior to LT (3.25), mechanical ventilation ≥48 hr (4.93), and renal replacement therapies (13.40). We developed a risk score for the prediction of bacterial infections with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.89) with sensitivity of 88% and specificity of 64%. In the infection group, mortality was higher than in controls (18.9% vs. 2.0%) with longer hospitalization (16 vs. 10 days; P < 0.001). We detected a high rate of bacterial infections leading to longer hospital stay and higher mortality rate. The formulated risk score can help predict bacterial infections; however, it requires clinical validation in further studies. K E Y W O R D S bacterial infections, Iran, liver transplantation, risk factors, scoring systems ---Abbreviations: AUC, area under the curve; CRRT, continuous renal replacement therapy; LT, liver transplantation; MDR, multidrug resistance; MELD, model for end-stage liver disease; ROC curve, receiver operating characteristic curve. | RESULTSDuring the study period, 399 LTs were performed on 389 adult patients. Ten (2.6%) patients received two transplants each: seven for post-transplant complications, two 408 | JAFARPOUR ET AL.

show abstract

Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta‐analysis

Wang

et al. 2021

Nut in Clin Prac

View full text Add to dashboard Cite

Probiotics were used for liver transplantation (LT) patients to reduce postoperative infection, but clinical trials examining the combined use of prebiotics and probiotics are limited. This meta‐analysis aimed to compare the safety and efficacy of combined use of prebiotics and probiotics in patients undergoing LT. PubMed, Cochrane, and Embase databases were reviewed for the combined use of prebiotics and probiotics in patients undergoing LT. The weighted mean difference (WMD), risk ratio (RR), and 95% CI were calculated. A total of 6 related studies comprising 345 patients were included. Most prebiotics and probiotics were given for 7.14 days. The overall infection rate (RR = 0.29; 95% CI, 0.14.0.60; P value for heterogeneity [PH] = .066; test for heterogeneity [I2] = 51.7%) and the incidence of urinary tract infection (RR = 0.14; 95% CI, 0.04–0.47, PH = .724; I2 = 0%) were lower in the probiotics group when compared with those in the control group. Furthermore, probiotics significantly reduced the hospital length of stay (WMD = −1.37; 95% CI, −1.92 to 0.82; PH = .506; I2 = 0%) and the duration of antimicrobial therapy (WMD = −4.31; 95% CI, −5.41 to 3.22; PH = .019; I2 = 69.8%) in patients undergoing LT. These findings suggested that the combined use of prebiotics and probiotics (Lactobacillus and Bifidobacterium) was effective in lowering the incidence of bacterial infections and shortening the hospital length of stay and duration of antibiotic therapy in patients undergoing LT, when compared with conventional nutrition.

show abstract

Bacterial infections in pediatric patients during early post liver transplant period: A prospective study in Iran

Abstract: These infections were associated with longer hospital stay and higher mortality rate. Conducting further studies with larger sample size and investigating more effective prophylactic measures should be considered in future studies.

Cited by 19 publications

References 31 publications

Bacterial Infections after Pediatric Liver Transplantation

Bacterial Infections after Pediatric Liver Transplantation

Bacterial infections in the early period after liver transplantation in adults: A prospective single‐center cohort study

Efficacy and safety of probiotics and prebiotics in liver transplantation: A systematic review and meta‐analysis

Contact Info

Product

Resources

About