Experience with the use of piperacillin–tazobactam in pediatric non‐renal solid organ transplantation

Abstract

Bacterial infection remains a major problem after solid organ transplantation (SOT), especially in children. Piperacillin-tazobactam (Pip-Tazo) is a beta-lactam-antibiotic combination with a broad spectrum of activity including gram-positive cocci as well as gram-negative rods, non-fermentative and anaerobic bacteria. The aim of this retrospective study was to critically review our experience with Pip-Tazo as perioperative prophylactic agent in pediatric non-renal SOT. Between 1993 and 2003 Pip-Tazo was used as initial perioperative prophylaxis in 45 pediatric patients who underwent a total of 49 transplants (36 liver-, seven cardiac-, two lung-, and four small bowel-) at our department. Median age of the children was 7.9 (range 0.5-18.1) years. A total of 34 rejection episodes following 27 transplants were diagnosed. During first hospitalization 44 infectious episodes were observed. Bacteria were responsible for 22 episodes including sepsis (n = 10), pneumonia (n = 5), wound infection (n = 4), urinary tract infection (n = 1), and clostridial colitis (n = 2). The isolated organisms were gram-positive cocci (n = 12), gram-negative rods (n = 3), non-fermentative bacilli (n = 4), and anaerobes (n = 3). Ten episodes were caused by Pip-Tazo resistant bacteria. Twenty-one of these infections were observed following antirejection therapy with pulse steroids. At later time points nine infectious episodes were successfully treated with a second course of Pip-Tazo. During follow up, eight patients died. Six deceased perioperatively: five from infection including aspergillosis (n = 4) and Pneumocystis jiroveci pneumonia (n = 1) and cerebrovascular bleeding (n = 1) and two children later on. At present 37 children (82%) are alive with well functioning graft after a median follow up of 39.2 (range 0.6-123.5) months. No severe side effects caused by Pip-Tazo were observed in any of the children. Pip-Tazo may be a suitable single agent for perioperative prophylaxis in pediatric non-renal solid organs recipients, however, a prospective comparative study is needed to make final conclusions.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…946 A small, retrospective, single-center cohort study reported outcomes of children undergoing liver, heart, small bowel, or lung transplantation receiving piperacillin-tazobactam 120-150 mg/kg/day beginning before surgical incision and continuing for 48 hours postoperatively and found favorable results, with a superficial SSI rate of 8% and no deep SSIs. 992 Recommendations. The recommended agents for patients undergoing liver transplantation are (1) piperacillin-tazobactam and (2) cefotaxime plus ampicillin ( Table 2).…”

Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery

“…The combination of cefotaxime plus ampicillin has been reportedly used in children undergoing living-related donor liver transplantation; the efficacy of this regimen appeared to be favorable [946]. A small, retrospective, single-center cohort study reported outcomes of children undergoing liver, heart, small bowel, or lung transplantation receiving piperacillin-tazobactam 120-150 mg/kg/day beginning before surgical incision and continuing for 48 h postoperatively and found favorable results, with a superficial SSI rate of 8% and no deep SSIs [992].…”

Clinical pharmacology of piperacillin-tazobactam combination in infants and children

“…Wiesmayr et al [15] performed a retrospective study to critically review their experience with piperacillin-tazobactam as well as perioperative prophylactic agent in paediatric non-renal solid organ transplantation. Between 1993 and 2003 piperacillin-tazobactam was used as initial perioperative prophylaxis in 45 paediatric patients who underwent a total of 49 transplants (36 liver, 7 cardiac, 2 lung, and 4 small bowel).…”