Bloodstream infections during the first year after pediatric small bowel transplantation

Diana F. Florescu, Fang Qiu, Alan N. Langnas, David F. Mercer, Heather Chambers, Lisa A. Hill, Noor Qaragholi, Andre C. Kalil

Research output: Contribution to journalReview article

27 Scopus citations

Abstract

Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients' characteristics were analyzed with Wilcoxon rank-sum, χ 2 or Fisher's exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test. Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1% of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3%) and intra-abdominal infections (32.9%). Central venous catheters were present in 86.3%, and total parenteral nutrition within 7 days before infection was administered in 72.6% of episodes. Gram-positive bacteria (96 isolates) were more frequently isolated than Gram-negative bacteria (52 isolates), with Enterococcus spp. being the most commonly identified (48 isolates), followed by coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation in patients with BSIs and 2 in patients without BSIs (P = 0.99). One-year survival rate for patients without BSIs was 86.7% (95% confidence interval: 68.3%-94.8%) versus 72.1% in patients with BSIs (95% confidence interval: 59.8%-81.2%). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056). Conclusions: Almost 70% of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.

Original languageEnglish (US)
Pages (from-to)700-704
Number of pages5
JournalPediatric Infectious Disease Journal
Volume31
Issue number7
DOIs
StatePublished - Jul 2012

Keywords

  • Bacteremia
  • Bloodstream infections
  • Fungemia
  • Intestinal
  • Pediatric
  • Small bowel
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

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