5 Years Experience at University of Nebraska Medical Center with Bloodstream Infections after Pediatric Small Bowel Transplantation

Abstract

Background: Limited data regarding the epidemiology of bloodstream infections (BSI) in small bowel transplant (SBT) recipients has been published. Methods: We reviewed the medical records of 98 pediatric patients who underwent SBT from January 2003 to December 2007. Patients characteristics were analyzed with Wilcoxon rank-sum, chi-square or Fisher's exact tests. We compared survival distributions between groups with log rank test. Results: 95 patients underwent one transplant and three patients underwent two transplants. The median age of the group was 1.48 years (range 0.62-17.58 years), and 53% were male. Characteristics of the patients presented in Table 1.Table: [Patients’ characteristics]68 patients (69.4%) developed at least one episode of BSI, with a total of 146 BSIs during the first year after transplantation. The median time-to-infection after transplant was 52.5 days (range 1-273 days). 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 coagulate-negative Staphylococcus (40 isolates). Patients who underwent combined-SBT were significantly younger than patient who underwent isolated-SBT [median age 1.3 years (range 0.6-13.8 years) vs. 2.4 (0.7-17.6 years); p=0.009] with similar gender distribution (p=0.57). Patients who developed BSIs were younger than those without BSIs [median age 1.4 years (range 0.6-14.6) vs. 2.1 (0.9-17.6); p=0.02], without a gender difference (p=0.97). Central line was present in 86.3% of the BSI and total parenteral infusion (TPN) was being administered in 72.6% BSIs during the 7 days prior infection. The sources of the BSIs were: central line 49.3%, abdomen 32.9%, lung 4.8%, skin and soft tissues 4.1%, urinary tract 0.7%, and unknown 7.5%. Acute cellular rejection was diagnosed in 8 (8.1%) patients, all of them had BSIs. PTLD was diagnosed in 18 (18.4%) patients of which 14 developed BSI. Six grafts were lost in the first year after transplantation, 4 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%CI: 68.3-94.8%) versus 72.1% in patients with BSIs (95%CI: 59.8-81.2%). Conclusions: Almost 70% patients developed infections after SBT, early after transplantation mainly related to a central line or intra-abdominal process. Patients with BSIs were younger than those without, the majority had central line and were on TPN. Patients without BSIs tended to have a better survival rate.