Impact of surveillance stool culture guided selection of antibiotics in the management of pediatric small bowel transplant recipients

Abstract

Surveillance stool cultures (SSC) have been used in immunocompromised populations to predict the organisms associated with invasive infections and aid in the selection of empiric antibiotic regimens. To evaluate the utility of this approach in pediatric small bowel transplant (SBT) recipients, we conducted a retrospective review of 33 patients who underwent SBT, 16 of whom had SSC done. In no case was the same organism isolated from SSC and subsequent blood, peritoneal fluid or wound cultures. In the first month post-transplantation, blood cultures were positive in 44% and 35% of patients that had and did not have SSC done, respectively (p = 0.73); peritoneal fluid cultures in 44% and 65% (p = 0.30); and wound cultures in 44% and 24% (p = 0.28). There were no significant differences among both groups in time to first infection, duration of ICU stay following SBT, graft survival or long-term patient survival. We conclude that SSC-guided antibiotic selection does not have a significant impact on the incidence of invasive infections in the first month following SBT or on specific indicators of patient outcome. This suggests that empiric antibiotic regimens should be selected based on clinical presentation and hospital flora and susceptibility patterns.

Six‐month incidence of bloodstream infections in intestinal transplant patients

“…Given that the majority of the isolated microbes are enteric bacteria, surveillance stool cultures have been used to guide antibiotic selection in intestinal transplant recipients in the peri‐operative period. However, in a retrospective study of 33 patients who underwent SBT, of the 16 patients who had surveillance stool cultures done, none of them had the same organism isolated from subsequent blood, peritoneal fluid, or wound cultures .…”

Infecção Bacteriana No Transplante Intestinal E Multivisceral – Revisão Da Literatura

“…Observou-se que os micro-organismos isolados em coprocultura não eram os mesmos isolados das infecções nos outros sítios (sangue, líquido peritoneal e ferida operatória). 16 Recentemente, trabalhos publicados vêm demonstrando redução na incidência de infecções bacterianas por Grampositivos nos TOS, apesar de permanecer elevada quando se analisam os germes isoladamente. 11,17 A prevalência de bactérias Gram-negativas MDR continua aumentando, bem como seu perfil de resistência.…”

“…12 Nos TI, TFI e TMV os dados são discordantes, não ocorrendo uma predominância clara de um dos grupos de agentes (Tabela 1). 5,16,[18][19][20][21][22][23] A incidência de infecção de corrente sanguínea foi maior nos pacientes com menor idade e a presença dessa infecção acarretou menor sobrevida. 23 A infecção da corrente sanguínea é a mais comum, com taxas de 1,4 episódios por paciente na população pediátrica e 1,55 episódios por paciente entre adultos, após TI ou TMV.…”