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Bacteremia in Pediatric Solid Organ Transplant Recipients within 1 Year of Transplant
Mario M Landa1, Ayelet Rosenthal1,2, Caitlin Naureckas Li1,2
1Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Insights
Bloodstream infections (BSI) after pediatric solid organ transplantation (SOT) occurred in 8.4% of patients, with higher rates in liver transplant recipients. Identifying risk factors can improve care and reduce hospitalizations.
Area of Science:
- Pediatric solid organ transplantation
- Infectious diseases
- Immunocompromised hosts
Background:
- Bacteremia poses significant risks in immunocompromised children.
- Limited data exists on bloodstream infections (BSI) post-pediatric solid organ transplantation (SOT).
Purpose of the Study:
- To determine the incidence and risk factors of BSI in pediatric SOT recipients.
- To analyze the impact of BSI on patient outcomes and healthcare utilization.
Main Methods:
- Retrospective review of 581 pediatric SOT recipients (heart, liver, kidney) over 14 years.
- Analysis of bloodstream infections (BSI) and associated clinical data.
Main Results:
- 1-year BSI incidence was 8.4%, highest in liver transplant recipients.
- Risk factors included younger age, earlier transplant period, repeat surgery, and pre-existing diabetes/tumor.
- Most BSIs occurred within 90 days, often linked to central lines; coagulase-negative staphylococci and enteric commensals were common.
- BSI did not increase mortality but led to more hospitalizations and longer hospital stays.
Conclusions:
- Pediatric SOT recipients experience significant BSI rates, though incidence decreased over time.
- Identifying BSI risk factors is crucial for developing targeted interventions.
- Interventions can potentially reduce inpatient care needs for pediatric SOT patients.
Background:
Bacteremia is a major cause of morbidity and mortality in immunocompromised children, yet there are limited data in children who have undergone solid organ transplantation (SOT).
Methods:
We retrospectively reviewed bloodstream infections (BSI) in 581 recipients of heart, liver, or kidney transplants over a 14-year period.
Results:
Overall 1-year incidence in this population was 8.4%, and was highest in recipients of liver transplants compared to heart or kidney. Younger age, transplantation earlier in the time period studied, need for repeat surgery within 30 days of transplant, and prior diagnosis of diabetes or tumor were associated with an increased risk of BSI. Most BSI occurred within 90 days of transplant, and most were associated with central venous lines. Coagulase-negative staphylococci and enteric commensals were commonly isolated. Multiple BSI within the year after transplant were uncommon. Although overall mortality was not increased in patients with BSI compared to those without, patients with BSI had more total hospitalizations and more days spent in the hospital in the year following SOT.
Conclusion:
In a large pediatric SOT population, overall BSI rates were significant but decreased over time. Identifying factors which contribute to BSI after SOT may direct interventions that can impact inpatient care requirements for these patients.
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