265. Identification of Solid-Organ Transplant Antimicrobial Stewardship Opportunities in Pediatric Liver Transplant Patients

Abstract

BackgroundThrough the prospective audit with feedback program, postoperative antimicrobial use for pediatric liver transplant was observed to extend beyond the recommended 24 hours for surgical site infection (SSI) prophylaxis. Bacterial infections in the immediate post-transplant period represent significant risk in pediatric liver-transplant recipients, including SSI. We describe our posttransplant antimicrobial (PTA) utilization in the largest pediatric liver transplant center to determine opportunities for the antimicrobial stewardship program (ASP).MethodsAll children who underwent a liver transplant between January 1, 2017 and September 30, 2017 at our institution were included. Antimicrobials initiated within 14 days posttransplant were captured, presence of fever within 14 days, positive microbiologic data within 30 days, and massive transfusion protocol (MTP) status were collected. The primary endpoint was duration of PTA. Clinical factors associated with PTA use >48 hours were evaluated.ResultsThirty-eight children underwent a liver transplant during the study period and 29 (76%) received a broad-spectrum Gram-negative (GN) antibiotic for > 48 hours posttransplant. Half of the patients received vancomycin and 15 (40%) received an antifungal posttransplant. Fever occurred in 21 (55%) of patients with a median onset of 1 day; 3 (8%) patients had a culture-proven posttransplant bacterial infection, with no resistant Gram-positive organisms identified. Eight patients (21%) met MTP and received PTA for ≥7 days and none had a positive bacterial culture. No differences were detected in fever or culture proven posttransplant infection between patients who received ≤48 hours of GN antibiotics compared with those who received >48 hours.ConclusionThe majority of children received PTA beyond 48 hours which was not attributable to prolonged posttransplant fevers or positive cultures. We identified ASP opportunities, including limiting GN antibiotics to 48 hours posttransplant, eliminating empiric vancomycin, restricting antifungals to MTP only, and limiting MTP PTA to 5 days.Disclosures All authors: No reported disclosures.