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Published on: May 7, 2015
Postoperative Infections and Antimicrobial Prophylaxis in the Pediatric Intensive Care Unit After Liver
Elise Kang1, Alicia M Alcamo2, Danielle K Maue3,4
1Department of Pediatrics, Columbia University Irving Medical Center, New York, USA.
Insights
Postoperative infections (POI) affect 23% of pediatric liver transplant patients in the ICU, with younger age and open fascia as key risk factors. These infections lead to worse outcomes, including longer hospital stays and increased mortality.
Area of Science:
- Pediatric Surgery
- Transplantation Medicine
- Infectious Diseases
Background:
- Postoperative infections (POI) are a significant concern following pediatric liver transplantation (LT).
- Understanding the incidence and risk factors for POI within the pediatric intensive care unit (PICU) is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the incidence and identify risk factors for POI in pediatric LT recipients during their PICU stay.
- To assess antimicrobial prophylaxis utilization across different transplant centers.
Main Methods:
- A multicenter, retrospective cohort study involving 327 pediatric LT recipients from 12 US centers over two years.
- Analysis of pre- and postoperative variables to identify POI risk factors.
- Multivariable logistic regression was used to evaluate independent predictors of POI.
Main Results:
- 23% of patients developed POI, most commonly bacterial or polymicrobial.
- Independent predictors of POI included younger age (<1 year), open fascia, and pre-transplant hospitalization.
- POI was associated with significantly longer hospitalizations, higher graft loss rates, and increased mortality.
Conclusions:
- Postoperative infections are common in pediatric liver transplant recipients in the PICU, impacting morbidity and mortality.
- Younger age, open fascia, and prior hospitalization are significant risk factors for POI.
- Further research is needed to optimize antimicrobial strategies and reduce POI incidence and associated complications.
Objective:
To determine the incidence and risk factors for postoperative infections (POI) after pediatric liver transplantation (LT) while in the pediatric intensive care unit (PICU).
Methods:
This is a multicenter, retrospective cohort study of isolated pediatric LT recipients from 12 LT centers in the United States over 2 years. Pre- and postoperative variables were examined to determine POI risk factors during the PICU admission. Antimicrobial prophylaxis utilization was assessed. Comparative statistics were performed using chi-squared and Mann-Whitney U tests. Multivariable logistic regression modeling evaluated POI risk factors.
Results:
76/327 (23%) patients developed POI (47% bacterial, 3% viral, 4% fungal, 22% polymicrobial, and 21% clinically adjudicated, culture negative). Abdominal/surgical site and bloodstream infections were most common at 29% and 26%, respectively. Independent predictors of POI included age under 1 (OR = 2.37 [95% CI 1.36-4.13], p = 0.002), open fascia (OR = 3.15 [95% CI 1.77-5.61], p < 0.001), and hospitalization pre-transplant (OR = 2.09 [95% CI 1.20-3.64], p = 0.009). Patients with POI had longer hospitalizations (23.0 days [17.0-34.0] vs. 13.0 days [9.0-20.0], p < 0.001), higher graft loss rates (9% vs. 0.4%, p < 0.001), and greater mortality (5% vs. 0.4%, p = 0.01). Significant variability in antimicrobial regimens existed amongst transplant centers.
Conclusions:
One in five patients developed POI while in the PICU. Predictors of POI included younger age, open fascia, and hospitalization pre-transplantation. POIs were associated with significant morbidity, including prolonged length of stay, graft loss, and mortality. Future prospective studies are needed to optimize antimicrobial regimens to prevent POI and improve outcomes.
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