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Comparison in outcome with tailored antibiotic prophylaxis postoperatively in pediatric intestinal transplant
Brandon Chatani1, Jennifer Garcia2, Chiara Biaggi2
1Pediatrics, Jackson Memorial Hospital, Miami, Florida.
Insights
Personalizing antibiotic prophylaxis after pediatric intestinal transplants may reduce bloodstream infections (BIs). Tailored regimens showed a trend toward delaying the first BI, suggesting improved patient outcomes in this vulnerable population.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Pediatric Gastroenterology
Background:
- Bloodstream infections (BSIs) are common in pediatric intestinal transplant recipients.
- Standardized antibiotic prophylaxis may not be optimal for all patients.
- Personalized treatment strategies are increasingly important in transplantation.
Purpose of the Study:
- To compare standardized versus tailored antibiotic prophylaxis regimens.
- To evaluate the impact on bloodstream infections and multidrug-resistant organisms (MDROs).
- To assess outcomes in pediatric intestinal transplant patients.
Main Methods:
- Retrospective analysis of pediatric intestinal transplant recipients.
- Comparison of patients receiving standardized vs. tailored antibiotic prophylaxis.
- Evaluation of time to first BSI, second BSI, and MDRO development.
Main Results:
- The standard prophylaxis group experienced significantly shorter time to and higher rates of BSIs (P < 0.001).
- No significant difference in time to a second BSI was observed between groups.
- The tailored group showed prolonged time to MDRO development, though not statistically significant.
Conclusions:
- Tailored prophylactic antibiotic regimens may delay the first BSI in pediatric intestinal transplant patients.
- Further research is needed to confirm the impact of tailored regimens on morbidity and mortality.
- History of MDRO significantly increases the risk of 1-year mortality post-transplant.
Abstract:
BIs are ubiquitous among the pediatric intestinal transplant patient population. Personalizing postoperative prophylaxis antibiotic regimens may improve outcomes in this population. A retrospective analysis of all pediatric patients who underwent intestinal transplantation was evaluated to compare standardized and tailored regimens of antibiotics provided as prophylaxis postoperatively. Patients in the standard group have both shorter time to and higher rate of BIs, which was statistically significant (P < 0.001). Of the children who developed a BI, there was no statistical difference in average times to the development of a second BI (293 vs 119 days, P = 0.211). The tailored group had prolonged times until the development of a MDRO (52.6 vs 63.9 days, P = 0.677). Although not statistically significant, the tailored group had a propensity to present with gram-negative pathogens after transplant as compared to the standard regimen group, which presented with gram-positive pathogens (P = 0.103). Children with a history of an MDRO held a 7.3 (P < 0.01) times more likelihood of death within a year of transplant. A tailored prophylactic antibiotic regimen in the post-transplant period appears to prolong the time to the first BI. Although the data do not show differences in mortality, further study may prove the impact of a tailored antibiotic regimen on morbidity and mortality rates.
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