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Published on: February 23, 2014
Invasive pneumococcal infections in pediatric cardiac transplant patients
S H Stovall1, K A Ainley, E O Mason
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Cardiac transplant patients face a higher risk of Streptococcus pneumoniae infections. African-American children, those transplanted before age 2, and recipients with idiopathic cardiomyopathy are most vulnerable. Pneumococcal vaccination may reduce this risk.
Area of Science:
- Pediatric cardiology
- Infectious diseases
- Transplant medicine
Background:
- Bacterial infections pose significant risks to cardiac transplant recipients.
- Streptococcus pneumoniae is a leading bacterial pathogen in children.
Purpose of the Study:
- To investigate the role and incidence of Streptococcus pneumoniae infections in pediatric cardiac transplant patients.
- To identify risk factors associated with invasive pneumococcal disease in this population.
Main Methods:
- Retrospective review of medical records for cardiac transplant patients from March 1990 to November 2000.
- Analysis of demographic, clinical, and microbiological data to identify invasive pneumococcal infections.
Main Results:
- 11% of patients (9 of 80) experienced 12 episodes of pneumococcal bacteremia (39 cases/1,000 patient-years).
- Increased risk observed in African-American patients, those transplanted before age 2, and recipients with idiopathic dilated cardiomyopathy.
- Only 1 of 6 eligible patients received the pneumococcal vaccine at the recommended age; 33% experienced recurrent infections.
Conclusions:
- Cardiac transplant patients have a higher incidence of pneumococcal bacteremia compared to the general pediatric population.
- Key risk factors include race, younger age at transplant, and specific underlying cardiac conditions.
- Pneumococcal vaccination is a plausible strategy to mitigate the risk of invasive pneumococcal disease in this vulnerable group.
Background:
Bacterial infections cause significant morbidity and mortality in cardiac transplant patients. Because Streptococcus pneumoniae is the most prominent bacterial pathogen of childhood, the objective of this study was to define the role of S. pneumoniae as a pathogen in the cardiac transplant population.
Methods:
Medical records of cardiac transplant patients from March, 1990, through November, 2000, were reviewed to identify invasive pneumococcal infections after transplantation. Demographic, clinical and microbiologic data were reviewed.
Results:
Nine (11%) of 80 patients had 12 episodes of pneumococcal bacteremia for an incidence rate of 39 cases/1,000 patient years. Patients who were African-American, transplanted before 2 years of age and transplanted because of idiopathic dilated cardiomyopathy were at increased risk of invasive pneumococcal disease (P < 0.05). Six patients were eligible for the 23-valent pneumococcal polysaccharide vaccine before their first invasive infection, but only 1 had received it at the recommended age. Most isolates (82%) were penicillin-susceptible, and no single serotype predominated. There were 2 deaths in the study group, but each was unrelated to infection. Three patients (33%) had recurrent invasive disease with a second serotype an average of 12 months after the first infection.
Conclusions:
The incidence of pneumococcal bacteremia in cardiac transplant patients is higher than in the general pediatric population. Risks for infection were being African-American, being younger than 2 years at the time of transplant and being transplanted because of idiopathic cardiomyopathy. It is plausible that pneumococcal vaccine would decrease this risk.
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