Late-onset bacteremia in uncomplicated pediatric liver-transplant recipients after a febrile episode

Quirós-Tejeira, Rubén E.; Ament, Marvin E.; McDiarmid, Sue V.; González, M Portas; Chong, Roberto; Vargas, Jorge; Martı́n, Martı́n G.

doi:10.1111/j.1432-2277.2002.tb00206.x

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…These time periods were chosen for the purposes of the detailed risk analyses for infections, as they represent the peak periods for the development of these types of infections (5)(6)(7)(8)(9)(10). Infants are defined as <1 year of age.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

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Rejection and infection are important adverse events after pediatric liver transplantation, not previously subject to concurrent risk analysis. Of 2291 children (<18 years), rejection occurred at least once in 46%, serious bacterial/fungal or viral infections in 52%. Infection caused more deaths than rejection (5.5% vs. 0.6% of patients, p < 0.001). Early rejection (<6 month) did not contribute to mortality or graft failure. Recurrent/chronic rejection was a risk in graft failure, but led to retransplant in only 1.6% of first grafts. Multivariate predictors of bacterial/fungal infection included recipient age (highest in infants), race, donor organ variants, bilirubin, anhepatic time, cyclosporin (vs. tacrolimus) and era of transplant (before 2002 vs. after 2002); serious viral infection predictors included donor organ variants, rejection, Epstein-Barr Virus (EBV) naivety and era; for rejection, predictors included age (lowest in infants), primary diagnosis, donor-recipient blood type mismatch, the use of cyclosporin (vs. tacrolimus), no induction and era. In pediatric liver transplantation, infection risk far exceeds that of rejection, which causes limited harm to the patient or graft, particularly in infants. Aggressive infection control, attention to modifiable factors such as pretransplant nutrition and donor organ options and rigorous age-specific review of the risk/benefit of choice and intensity of immunosuppressive regimes is warranted.

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Section: Discussionmentioning

confidence: 99%

“…All SPLIT centers have Institutional Review Board approval and individual informed consent is obtained from parents and/or guardians (5)(6)(7). Coded information is submitted to the SPLIT data-coordination center at the time of listing for liver transplant (LT).…”

Section: Patient Populationmentioning

confidence: 99%

Risk Factors for Rejection and Infection in Pediatric Liver Transplantation

Shepherd

Turmelle

Nadler

et al. 2008

American Journal of Transplantation

135

105

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“…11 Other investigators have similarly not found the complete blood count components predictive of bacteremia beyond 2 months posttransplant in pLTRs. 11,17 Across the 3 centers in our study, other inflammatory markers were infrequently obtained. Data in adults and children suggests that C-reactive protein and procalcitonin may be more sensitive biomarkers than the WBC, ABC or ANC to identify transplant patients with bacteremia.…”

Section: Discussionmentioning

confidence: 92%

“…The prevalence of bacteremia we noted was lower than previously reported, likely attributable to our restriction to those encounters in the outpatient rather than the inpatient setting. 6,17,18 However, bacteremia remained an important cause of infection in the first 2 years post-transplant.…”

Section: Discussionmentioning

confidence: 99%

Bacteremia in Pediatric Liver Transplant Recipients

Lubell,

Cruz,

Tanverdi

et al. 2023

Pediatric Infectious Disease Journal

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Background: We aimed to determine the frequency of bacteremia, septic shock and bacterial meningitis in pediatric liver transplant recipients (pLTRs) in the outpatient setting and to identify clinical factors associated with bacteremia. Methods: Multicenter retrospective study of pLTRs evaluated in the emergency department or outpatient clinic between 2010 and 2018 for suspected infection, defined as fever ≥38 °C or a blood culture obtained. We excluded patients with nontransplant immunodeficiency, multiorgan transplants or intestinal failure. The primary outcome was bacteremia; secondary outcomes included fluid-refractory septic shock, bacterial meningitis and antibiotic resistance. The unit of analysis was the encounter. Results: A total of 151 children had 336 encounters for infection evaluation within 2 years of transplant. Of 307 (91.4%) encounters with blood cultures, 17 (5.5%) had bacteremia, with 10 (58.8%) occurring within 3 months of transplant. Fluid-refractory septic shock and bacterial meningitis occurred in 7 of 307 (2.8%) and 0 of 307 encounters, respectively. Factors associated with bacteremia included closer proximity to transplant (<3 months) [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3–9.8; P = 0.01], shorter duration of illness (OR: 4.3; 95% CI: 1.5–12.0; P < 0.01) and the presence of a central venous catheter (CVC) (OR: 12.7; 95% CI: 4.4–36.6; P < 0.01). However, 5 (29.4%) encounters with bacteremia had none of these factors. Among Gram-positive pathogens, 1 of 7 (14.2%) isolates were resistant to vancomycin. Among Gram-negative pathogens, 3 of 13 (23.1%) isolates were resistant to 3rd generation cephalosporins. Conclusions: Bacteremia was an important cause of infection within 2 years of pLTR. Clinical factors increased the risk of bacteremia. Further, large sample studies should derive multivariable models to identify those at high and low risk of bacteremia to optimize antibiotic use.

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