Early Bacterial Infections After Pediatric Liver Transplantation in the Era of Multidrug-resistant Bacteria: Nine-year Single-center Retrospective Experience
Autor: | Carmen Capito, Dominique Debray, Naïm Bouazza, Agathe Béranger, Florence Moulin, Christophe Chardot, Pierre Frange, Sylvain Renolleau, Mehdi Oualha, Muriel Girard, Florence Lacaille, Agnès Ferroni |
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Rok vydání: | 2020 |
Předmět: |
Microbiology (medical)
Male medicine.medical_specialty Time Factors Klebsiella pneumoniae medicine.medical_treatment Microbial Sensitivity Tests Liver transplantation 03 medical and health sciences 0302 clinical medicine Antibiotic resistance Enterobacteriaceae Risk Factors 030225 pediatrics Internal medicine Drug Resistance Multiple Bacterial Epidemiology medicine Humans 030212 general & internal medicine Child Retrospective Studies biology business.industry Enterobacteriaceae Infections Infant Retrospective cohort study Odds ratio Antimicrobial biology.organism_classification Anti-Bacterial Agents Liver Transplantation Infectious Diseases Carriage Child Preschool Pediatrics Perinatology and Child Health Female business |
Zdroj: | The Pediatric infectious disease journal. 39(8) |
ISSN: | 1532-0987 |
Popis: | Background Early bacterial infection is a major and severe complication after liver transplantation (LT). The rise of antimicrobial resistance, especially extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), is a growing concern for these patients. This study aimed to assess the epidemiology of early bacterial infections in a pediatric population, including those caused by multidrug-resistant (MDR) pathogens, and to identify risk factors for infection. Methods We conducted a monocentric retrospective study including 142 consecutive LTs performed in 137 children between 2009 and 2017. Results Ninety-three bacterial infections occurred after 67 (47%) LTs. Among the 82 isolated pathogens, the most common was Klebsiella pneumoniae (n = 19, 23%). Independent risk factors for early bacterial infection were low weight [odds ratio (OR) = 0.96; 95% confidence interval (CI): 0.9-0.99; P = 0.03] and the presence of a prosthetic mesh (OR = 2.4; 95% CI: 1.1-5.4; P = 0.046). Sixty-one children (45%) carried MDR bacteria and 16 infections were caused by MDR pathogens, especially ESBL-producing K. pneumoniae (n = 12). ESBL-PE stool carriage was associated with ESBL-PE infection (OR = 4.5; 95% CI: 1.4-17.4; P = 0.02). Four children died from an infection, three due to ESBL-producing K. pneumoniae. Conclusions This study confirmed a shift toward a predominance of Gram-negative early bacterial infections after pediatric LT. The risk factors for infection were low weight and the presence of a prosthetic mesh. ESBL-PE stool carriage was associated with ESBL-PE infection. Adapted antimicrobial prophylaxis and personalized antibiotherapy are mandatory to reduce infection prevalence and mortality. |
Databáze: | OpenAIRE |
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