Bloodstream infections during the first year after pediatric small bowel transplantation

Diana F Florescu, Fang Qiu, Alan Norman Langnas, David F Mercer, Heather Chambers, Lisa A. Hill, Noor Qaragholi, Andre C Kalil

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients' characteristics were analyzed with Wilcoxon rank-sum, χ 2 or Fisher's exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test. Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1% of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3%) and intra-abdominal infections (32.9%). Central venous catheters were present in 86.3%, and total parenteral nutrition within 7 days before infection was administered in 72.6% of episodes. Gram-positive bacteria (96 isolates) were more frequently isolated than Gram-negative bacteria (52 isolates), with Enterococcus spp. being the most commonly identified (48 isolates), followed by coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation in patients with BSIs and 2 in patients without BSIs (P = 0.99). One-year survival rate for patients without BSIs was 86.7% (95% confidence interval: 68.3%-94.8%) versus 72.1% in patients with BSIs (95% confidence interval: 59.8%-81.2%). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056). Conclusions: Almost 70% of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.

Original languageEnglish (US)
Pages (from-to)700-704
Number of pages5
JournalPediatric Infectious Disease Journal
Volume31
Issue number7
DOIs
StatePublished - Jul 1 2012

Fingerprint

Transplantation
Pediatrics
Infection
Central Venous Catheters
Enterococcus
Survival
Confidence Intervals
Intraabdominal Infections
Total Parenteral Nutrition
Coagulase
Gram-Positive Bacteria
Gram-Negative Bacteria
Staphylococcus
Medical Records
Survival Rate
Transplants

Keywords

  • Bacteremia
  • Bloodstream infections
  • Fungemia
  • Intestinal
  • Pediatric
  • Small bowel
  • Transplant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Bloodstream infections during the first year after pediatric small bowel transplantation. / Florescu, Diana F; Qiu, Fang; Langnas, Alan Norman; Mercer, David F; Chambers, Heather; Hill, Lisa A.; Qaragholi, Noor; Kalil, Andre C.

In: Pediatric Infectious Disease Journal, Vol. 31, No. 7, 01.07.2012, p. 700-704.

Research output: Contribution to journalReview article

@article{ff052552f2cb45b682a4d71e8912b9e0,
title = "Bloodstream infections during the first year after pediatric small bowel transplantation",
abstract = "Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients' characteristics were analyzed with Wilcoxon rank-sum, χ 2 or Fisher's exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test. Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1{\%} of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3{\%}) and intra-abdominal infections (32.9{\%}). Central venous catheters were present in 86.3{\%}, and total parenteral nutrition within 7 days before infection was administered in 72.6{\%} of episodes. Gram-positive bacteria (96 isolates) were more frequently isolated than Gram-negative bacteria (52 isolates), with Enterococcus spp. being the most commonly identified (48 isolates), followed by coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation in patients with BSIs and 2 in patients without BSIs (P = 0.99). One-year survival rate for patients without BSIs was 86.7{\%} (95{\%} confidence interval: 68.3{\%}-94.8{\%}) versus 72.1{\%} in patients with BSIs (95{\%} confidence interval: 59.8{\%}-81.2{\%}). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056). Conclusions: Almost 70{\%} of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.",
keywords = "Bacteremia, Bloodstream infections, Fungemia, Intestinal, Pediatric, Small bowel, Transplant",
author = "Florescu, {Diana F} and Fang Qiu and Langnas, {Alan Norman} and Mercer, {David F} and Heather Chambers and Hill, {Lisa A.} and Noor Qaragholi and Kalil, {Andre C}",
year = "2012",
month = "7",
day = "1",
doi = "10.1097/INF.0b013e318256f9c3",
language = "English (US)",
volume = "31",
pages = "700--704",
journal = "Pediatric Infectious Disease Journal",
issn = "0891-3668",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Bloodstream infections during the first year after pediatric small bowel transplantation

AU - Florescu, Diana F

AU - Qiu, Fang

AU - Langnas, Alan Norman

AU - Mercer, David F

AU - Chambers, Heather

AU - Hill, Lisa A.

AU - Qaragholi, Noor

AU - Kalil, Andre C

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients' characteristics were analyzed with Wilcoxon rank-sum, χ 2 or Fisher's exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test. Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1% of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3%) and intra-abdominal infections (32.9%). Central venous catheters were present in 86.3%, and total parenteral nutrition within 7 days before infection was administered in 72.6% of episodes. Gram-positive bacteria (96 isolates) were more frequently isolated than Gram-negative bacteria (52 isolates), with Enterococcus spp. being the most commonly identified (48 isolates), followed by coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation in patients with BSIs and 2 in patients without BSIs (P = 0.99). One-year survival rate for patients without BSIs was 86.7% (95% confidence interval: 68.3%-94.8%) versus 72.1% in patients with BSIs (95% confidence interval: 59.8%-81.2%). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056). Conclusions: Almost 70% of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.

AB - Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients' characteristics were analyzed with Wilcoxon rank-sum, χ 2 or Fisher's exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test. Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1% of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3%) and intra-abdominal infections (32.9%). Central venous catheters were present in 86.3%, and total parenteral nutrition within 7 days before infection was administered in 72.6% of episodes. Gram-positive bacteria (96 isolates) were more frequently isolated than Gram-negative bacteria (52 isolates), with Enterococcus spp. being the most commonly identified (48 isolates), followed by coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation in patients with BSIs and 2 in patients without BSIs (P = 0.99). One-year survival rate for patients without BSIs was 86.7% (95% confidence interval: 68.3%-94.8%) versus 72.1% in patients with BSIs (95% confidence interval: 59.8%-81.2%). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056). Conclusions: Almost 70% of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.

KW - Bacteremia

KW - Bloodstream infections

KW - Fungemia

KW - Intestinal

KW - Pediatric

KW - Small bowel

KW - Transplant

UR - http://www.scopus.com/inward/record.url?scp=84862766376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84862766376&partnerID=8YFLogxK

U2 - 10.1097/INF.0b013e318256f9c3

DO - 10.1097/INF.0b013e318256f9c3

M3 - Review article

C2 - 22466325

AN - SCOPUS:84862766376

VL - 31

SP - 700

EP - 704

JO - Pediatric Infectious Disease Journal

JF - Pediatric Infectious Disease Journal

SN - 0891-3668

IS - 7

ER -