Comparison in outcome with tailored antibiotic prophylaxis postoperatively in pediatric intestinal transplant population

Abstract

BIs are ubiquitous among the pediatric intestinal transplant patient population. Personalizing postoperative prophylaxis antibiotic regimens may improve outcomes in this population. A retrospective analysis of all pediatric patients who underwent intestinal transplantation was evaluated to compare standardized and tailored regimens of antibiotics provided as prophylaxis postoperatively. Patients in the standard group have both shorter time to and higher rate of BIs, which was statistically significant (P < 0.001). Of the children who developed a BI, there was no statistical difference in average times to the development of a second BI (293 vs 119 days, P = 0.211). The tailored group had prolonged times until the development of a MDRO (52.6 vs 63.9 days, P = 0.677). Although not statistically significant, the tailored group had a propensity to present with gram-negative pathogens after transplant as compared to the standard regimen group, which presented with gram-positive pathogens (P = 0.103). Children with a history of an MDRO held a 7.3 (P < 0.01) times more likelihood of death within a year of transplant. A tailored prophylactic antibiotic regimen in the post-transplant period appears to prolong the time to the first BI. Although the data do not show differences in mortality, further study may prove the impact of a tailored antibiotic regimen on morbidity and mortality rates.

A metagenomic prospective cohort study on gut microbiome composition and clinical infection in small bowel transplantation

“… 62 Our study provides preliminary metagenomic data in SBT recipients that could help inform strategies to tailor antimicrobial plans for individuals to lengthen the time to first bloodstream infection without encouraging the development of further AMR. 63 …”

Multidrug-resistant organisms: A significant cause of severe sepsis in pediatric intestinal and multi-visceral transplantation

“…Although there are limited data regarding peri‐operative antibiotic prophylaxis for MVTx, it is routinely utilized due to exceedingly high rates of surgical site infections (14%–53%) 37,38 . Tailoring antibiotic prophylaxis post‐operatively has been shown to delay the development of MDRO infections in the pediatric intestinal transplant population 39 . The guidelines from the Infectious Diseases Society of America (IDSA), American Society of Health‐System Pharmacists (ASHP), Surgical Infection Society (SIS), and Society for Healthcare Epidemiology of America (SHEA) do not provide specific recommendations for post‐operative antibiotic prophylaxis in ITx or MVTx patients.…”

“…37,38 Tailoring antibiotic prophylaxis postoperatively has been shown to delay the development of MDRO infections in the pediatric intestinal transplant population. 39 The guidelines from the Infectious Diseases Society of America (IDSA), American Society of Health-System Pharmacists (ASHP), Surgical…”

Care of Pediatric Solid Organ Transplant Recipients: An Overview for Primary Care Providers

“…SOT recipients are at greatest risk of bacterial and/or fungal infections when they are most severely immunosuppressed. 57 After surgery, they are prone to superficial wound infections and deep infections near the transplanted organ as well as hospital-acquired infections with multidrug-resistant organisms. 15,53 The presence of indwelling catheters increases the risk of bacterial and/or fungal infections.…”