Frequency of Bacteremia and Urinary Tract Infection in Pediatric Renal Transplant Recipients.

Autor:	Cruz AT; From the Divisions of Emergency Medicine and Infectious Diseases.; Department of Pediatrics, Baylor College of Medicine, Houston, Texas., Tanverdi MS; Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado., Swartz SJ; Division of Nephrology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas., Dayan PS; Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York for the Pediatric Emergency Medicine Northeast, West, and South (PEM NEWS) Node of the Pediatric Emergency Care Applied Research Network (PECARN), New York, New York., Combs VA; Section of Pediatric Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado.; Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado., Lubell TR; Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York for the Pediatric Emergency Medicine Northeast, West, and South (PEM NEWS) Node of the Pediatric Emergency Care Applied Research Network (PECARN), New York, New York.
Jazyk:	angličtina
Zdroj:	The Pediatric infectious disease journal [Pediatr Infect Dis J] 2022 Dec 01; Vol. 41 (12), pp. 997-1003. Date of Electronic Publication: 2022 Sep 08.
DOI:	10.1097/INF.0000000000003701
Abstrakt:	Background: Our primary goal was to determine the frequency of bacteremia and urinary tract infections (UTI) in pediatric renal transplant recipients presenting with suspected infection within 2 years of transplant and to identify clinical and laboratory factors associated with bacteremia. Methods: We conducted a retrospective cross-sectional study for all pediatric ( < 18 years old) renal transplant recipients seen at 3 large children's hospitals from 2011 to 2018 for suspected infection within 2 years of transplant date, defined as pyrexia ( > 38°C) or a blood culture being ordered. Patients with primary immunodeficiencies, nontransplant immunosuppression, intestinal failure, and patients who had moved out of the local area were excluded. The primary outcome was bacteremia or UTI; secondary outcomes included pneumonia, bacterial or fungal meningitis, respiratory viral infections, and antibiotic resistance. The unit of analysis was the visit. Results: One hundred fifteen children had 267 visits for infection evaluation within 2 years of transplant. Bacteremia (with or without UTI) was diagnosed in 9/213 (4.2%) and UTIs in 63/189 (33.3%). Tachycardia and hypotension were present in 66.7% and 0% of visits with documented bacteremia, respectively. White blood cell (12,700 cells/mm 3 vs. 10,900 cells/mm 3 ; P = 0.43) and absolute neutrophil count (10,700 vs. 8200 cells/mm 3 ; P = 0.24) were no different in bacteremic and nonbacteremic patients. The absolute band count was higher in children with bacteremia (1900 vs. 600 cells/mm 3 ; P = 0.02). Among Gram-negative pathogens, antibiotic resistance was seen to 3rd (14.5%) and 4th (3.6%) generation cephalosporins, 12.7% to semisynthetic penicillins, and 3.6% to carbapenems. Conclusions: Bacteremia or UTIs were diagnosed in one-quarter of all pediatric renal transplant recipients presenting with suspected infection within 2 years of transplant. Evaluations were highly variable, with one-third of visits not having urine cultures obtained. No single demographic, clinical or laboratory variable accurately identified patients with bacteremia, although combinations of findings may identify a high-risk population. Competing Interests: S.J.S. has consulted for Fresenius Medical Care North America on COVID-19 vaccination delivery to children. The remaining authors have no conflicts of interest to disclose. (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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