Aeromonas Bacteremia in Pediatric Liver Transplant Recipients: Case-Based Experience of an Under-Recognized Infection

Aeromonas species can cause bacteremia, but their epidemiology and clinical significance in pediatric liver transplant (LT) recipients are unclear. We evaluated the incidence, clinical features, management, and outcomes of Aeromonas bacteremia in this population.

We performed a retrospective observational study at a tertiary pediatric LT center from November 2005 to April 2023. Patients who underwent LT before 18 years of age were reviewed, and cases of Aeromonas bacteremia were analyzed in detail.

Among 746 children who underwent LT, five episodes of Aeromonas bacteremia were identified. The incidence was 0.82 cases per 1000 person-years. Median age at LT was 2 years, and median interval from LT to bacteremia was 6 years (range, 2 months-24 years). All patients were receiving maintenance immunosuppression without neutropenia or significant liver dysfunction, and none were receiving antibiotics, including trimethoprim-sulfamethoxazole prophylaxis at the time of Aeromonas bacteremia. No patient had recent hepatobiliary procedures or biliary obstruction. All presented with fever; three had fever without source, and three reported freshwater exposure. Blood cultures yielded A. hydrophila/caviae (n = 3) or A. sobria (currently A. veronii biovar sobria) (n = 2). All isolates were susceptible to the empiric antibiotic regimens. Definitive therapy consisted of cefotaxime or cefepime, with or without metronidazole. All patients survived without progression to life-threatening sepsis or relapse.

In pediatric LT recipients, Aeromonas bacteremia can occur late after transplantation under mild immunosuppression and without recognizable biliary risk factors. Early recognition and appropriate antibiotic therapy may contribute to favorable outcomes.