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Published on: February 23, 2014
Frequency of Culture-proven Bacterial Infection and Radiographic Pneumonia in Pediatric Heart Transplant Recipients
Melisa S Tanverdi1, Tamar R Lubell2, Melanie D Everitt3
1From the Section of Pediatric Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Insights
Infections are a major risk for pediatric heart transplant recipients. Over 15% of suspected infections were bacterial or pneumonia, but clinical signs were not reliable predictors.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Transplant Medicine
Background:
- Infection is a significant cause of mortality following pediatric heart transplants (PHTs).
- Understanding common pathogens is crucial for optimizing diagnostic strategies and empirical antibiotic administration in PHT patients.
Purpose of the Study:
- To investigate the incidence and characteristics of culture-proven bacterial infections and radiographic pneumonia in pediatric heart transplant recipients presenting with suspected infections.
- To identify clinical and laboratory predictors of bacterial infection or pneumonia in this vulnerable population.
Main Methods:
- A retrospective study was conducted across three centers, analyzing data from pediatric heart transplant recipients (≤18 years) from 2010 to 2018.
- Suspected infections were defined by fever, elevated temperature, or blood culture acquisition within two years post-transplant.
- Primary outcomes included culture-proven bacterial infection or radiographic pneumonia; secondary outcomes involved septic shock, antibiotic resistance, and viral infections.
Main Results:
- Out of 193 children, 108 (56.0%) experienced at least one suspected infection encounter.
- Culture-proven bacterial infection or radiographic pneumonia occurred in 15.5% of 258 encounters, with 88.8% managed in the emergency department.
- Clinical and laboratory findings were similar between patients with and without confirmed bacterial infection or pneumonia, indicating limited predictive value.
Conclusions:
- Pediatric heart transplant recipients with suspected infections have a substantial risk (over 15%) of culture-proven bacterial infection or radiographic pneumonia.
- The lack of distinct clinical or laboratory markers highlights challenges in early identification.
- Standardizing diagnostic approaches may improve the detection of infections and support antimicrobial stewardship efforts.
Background:
Infection is a leading cause of death after pediatric heart transplants (PHTs). Understanding of common pathogens is needed to guide testing strategies and empiric antibiotic use.
Methods:
We conducted a 3-center retrospective study of PHT recipients ≤18 years old presenting to cardiology clinics or emergency departments (EDs) from 2010 to 2018 for evaluation of suspected infections within 2 years of transplant. Suspected infection was defined as (1) chief complaint of fever and/or (2) visit temperature ≥38 °C, and/or (3) blood culture obtained. The primary outcome was a culture-proven bacterial infection or radiographic pneumonia. Secondary outcomes included fluid-refractory septic shock, antibiotic resistance, respiratory viral infections and diagnostic testing. The unit of analysis was the encounter.
Results:
Of 193 children meeting inclusion criteria, 108 (56.0%) had ≥1 visit for suspected infection. Of 258 total encounters, 88.8% occurred in the ED and 52.8% resulted in admission. Culture-proven bacterial infection (4.3%) or radiographic pneumonia (11.6%) was documented in 15.5% of encounters; 1 (0.4%) had bacteremia. Antibiotics were administered in 33.7% of encounters, and 3 (1.2%) required inotropic support for fluid-refractory shock. Viral testing was sent in 162 encounters (62.8%), and 52% detected viral pathogens. Clinical characteristics and routinely obtained laboratory testing were similar in encounters with and without culture-proven bacterial infection or radiographic pneumonia.
Conclusions:
Over 15% of PHT recipients presenting with suspected infection had culture-proven bacterial infection or radiographic pneumonia. No single clinical or laboratory variable accurately identified these patients, potentially due to variability in testing. A more standardized approach could augment diagnostic and antimicrobial stewardship.
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