Candida infection in pediatric liver transplant recipients

Abstract

A retrospective review of 100 liver transplantations in 98 children was performed to determine the incidence of infection caused by Candida organism in these patients and to identify risk factors that may predispose to serious fungal infection. Thirty-one infections caused by Candida organisms developed during the initial 28 days posttransplantation: 19 were definite invasive infections (one deep site or one positive blood culture), 2 were probable invasive infections (three superficial sites), and 10 were urinary tract infections. Eleven of 19 patients had fungemia or a disseminated infection (two noncontiguous deep organs involved and/or positive blood cultures) and 8 of 19 had peritoneal candidiasis. Infection caused by Candida organisms was a contributing factor to mortality in 7 of 21 patients (case fatality rate of 33%) with invasive infection. Risk factors that were predictive for invasive infection by univariate analysis included the following: pretransplantation antibiotic therapy, length of transplant operation, transfusion requirement, number of days in the intensive care unit, number of days intubated, number of concurrent bacterial infections, number of antibiotics administered, number of laparotomies performed posttransplantation, retransplantation, hepatic artery thrombosis, bile leaks, and renal and respiratory failure. By logistic regression analysis, bile leak, hepatic artery thrombosis, preoperative steroid use, transfusion requirement, and the number of days intubated were identified as independent risk factors for invasive infection caused by Candida organisms. The use of prophylactic antifungal agents in high-risk patients may be important in reducing the serious morbidity and mortality associated with sepsis caused by Candida organisms in pediatric liver transplant recipients.

Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience

“…Other risk factors for bacterial infections included surgical issues and technical complexity of surgery, which is in accordance with previous reports. 8,22,24,25,34 We and others found that preoperative ascites was an independent risk factor for fungal infection. 35 This can be attributed to patients with preoperative ascites who are usually malnourished and more susceptible to fungal infection, as noted by A total of 3 cases had no definite organism and were diagnosed by chest x-ray and CT. 8 ; moreover, we also found that prolonged insertion of an intravascular catheter was an independent risk factor for fungal infection.…”

Risk Factors and Impact of .BETA.-D Glucan on Invasive Fungal Infection for the Living Donor Liver Transplant Recipients

“…Many reports have been published about risk factors for invasive fungal infection in recipients of deceased donor liver grafts (Gladdy et al 1999;Fortun et al 2002); on the other hand, there have been no reports about the risk factors for living donor liver transplantation (LDLT). Most LDLTs are elective surgery, thus it is possible to treat pre-existing infections and prepare the patient by administering prophylactic agents.…”

Immunizations and infectious diseases in pediatric liver transplantation

“…Likewise, the development of bile leaks and bowel perforations are associated with polymicrobial intraabdominal infections in the first month after LTx. 25 Finally, re-exploration of the abdomen is associated with increased rates of fungal infection. 13 Intermediate Period Days)…”

“…The recovery of Candida from a JacksonPratt drain in the early postoperative period may occur prior to the onset of clinical symptoms of intra-abdominal infection. 25 Such a recovery should prompt initiation of antimicrobial therapy and an aggressive evaluation of the presence of the source of the infection. Early initiation of treatment is particularly important, given an attributable mortality rate of up to 33% for Candida infections in pediatric liver transplant recipients.…”

“…Early initiation of treatment is particularly important, given an attributable mortality rate of up to 33% for Candida infections in pediatric liver transplant recipients. 25 The availability of fluconazole and the newer echinocandin antifungal agents (eg, caspofungin and micofungin) has increased the number of therapeutic options for Candida infections. However, resistance to the azoles is an increasing concern, as are drug-drug interactions between azoles and echinocandins with both cyclosporine and tacrolimus.…”