Bacterial and fungal bloodstream infections in pediatric liver and kidney transplant recipients

Dina Leth Møller,Andreas Dehlbæk Knudsen,Omid Rezahosseini,Susanne Dam Nielsen,Jenny Dahl Knudsen,Søren Schwartz Sørensen,Neval Ete Wareham,Allan Rasmussen

doi:10.1186/s12879-021-06224-2

Abstract

BackgroundBacterial and fungal bloodstream infections (BSI) are common after pediatric liver and kidney transplantations and associated with morbidity and mortality. However, knowledge about incidence rates, pathogen composition, and resistance patterns is limited. We aimed to describe the pattern of bacterial and fungal BSI in a cohort of pediatric liver and kidney transplant recipients.MethodsA prospective study of 85 pediatric liver and kidney transplant recipients transplanted from 2010 to 2017 with a total of 390 person-years of follow-up. Clinical characteristics and BSI were retrieved from national registries assuring nationwide follow-up for at least 1 year. BSI incidence rates and pathogen composition were investigated and stratified by the time post-transplantation and type of transplanted organ.ResultsA total of 29 BSI were observed within the first 5 years post-transplantation with 16 different pathogens. The overall incidence rate of first BSI was 1.91 per 100 recipients per month (95% CI, 1.1–3.1) in the first year post-transplantation. The most common pathogens were Enterococcus faecium, Candida albicans, Escherichia coli, and Klebsiella pneumoniae. The pathogen composition depended on the transplanted organ with a higher proportion of BSI with Enterobacterales in kidney transplant recipients than in liver transplant recipients (67% vs. 20%, p = 0.03), while multiple pathogens were detected in the liver transplant recipients.ConclusionsBSI were common in pediatric liver and kidney transplant recipients and the pathogen composition differed between liver and kidney transplant recipients. Guidelines for empiric antibiotic therapy should consider the type of transplanted organ as well as the local resistance patterns.

Highlights

The outcome of liver and kidney transplantations in children has improved over the last decades with a 5year survival of 85–96% [1, 2]
We prospectively examined all bacterial and fungal bloodstream infections (BSI) in pediatric liver and kidney transplant recipients at a tertiary pediatric transplantation center during the period 2010–2017 to evaluate the BSI incidence rates, BSI pathogen composition, and mortality after BSI during the first year post-transplantation
Characteristics of the pediatric liver and kidney transplant recipients and the blood cultures We included 85 pediatric liver, kidney, or combined liver and kidney transplant recipients into our cohort (Table 1) corresponding to all pediatric liver and combined liver and kidney transplantations and 46% of pediatric kidney transplantations performed in Denmark during the inclusion period

Summary

Introduction

The outcome of liver and kidney transplantations in children has improved over the last decades with a 5year survival of 85–96% [1, 2]. BSI have been reported in up to 25% of pediatric liver transplant recipients within the first year post-transplantation [6]. In adult liver and kidney transplant recipients, the incidence rate (IR) of infections and the pathogen composition (bacteria, fungal, and virus) change during the first year post-transplantation [7]. Little is known about the pattern of infections over time in pediatric liver and kidney transplant recipients. Bacterial and fungal bloodstream infections (BSI) are common after pediatric liver and kidney transplantations and associated with morbidity and mortality. Knowledge about incidence rates, pathogen composition, and resistance patterns is limited. We aimed to describe the pattern of bacterial and fungal BSI in a cohort of pediatric liver and kidney transplant recipients

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