Pediatr Infect Vaccine.  2018 Aug;25(2):82-90. 10.14776/piv.2018.25.e3.

Bacterial Infections after Liver Transplantation in Children: Single Center Study for 16 Years

• Kim JC
• Kim SJ
• Yun KW
• Choi EH
• Yi NJ
• Suh KS
• Lee KW
• Lee HJ

• KMID: 2418540
• DOI: http://doi.org/10.14776/piv.2018.25.e3

Abstract

PURPOSE
Survival after liver transplantation (LT) has improved over the years, but infection is still a major complication. We aimed to identify the characteristics of bacterial infections in pediatric LT recipients.
METHODS
This study is a retrospective review of 189 consecutive children undergoing LT between 2000 and 2015 at a single center. In this study, the incidence of infection was determined for the following periods: within 1 month, between 1-5 months, and between 6-12 months. Patients who underwent liver transplants more than once or multiple organ transplants were excluded.
RESULTS
All patients had received postoperative antibiotic for 3 days. Only the maintenance immunosuppression with oral tacrolimus and steroids were performed. As a result, 132 bacterial infections developed in 87 (46.0%) patients (0.70 events per person-year). Bacterial infections occurred most frequently within the first month (n=84, 63.6%) after LT. In the pathogens, Staphylococcus aureus (15.2%), Enterococcus species (15.2%), and Klebsiella species (13.6%) were most common. Regarding the organ infected, bloodstream was most common (n=39, 29.5%), followed by peritoneum (n=28, 21.2%), urinary tract (n=25, 18.9%), and lungs (n=20, 15.2%). We changed prophylactic antibiotics from ampicillin-sulbactam to piperacillin-tazobactam at 2011, October, there were no significant effects in the prevalence of antibiotics resistant bacterial infections. The 1-year mortality was 9.0% (n=17), in which 41.2% (n=7) was attributable to bacterial infection; septicemia (n=4), pneumonia (n=2), and peritonitis (n=1).
CONCLUSIONS
The incidence and type of bacterial infectious complications after LT in pediatric patients were similar to those of previous studies. Bacterial complications affecting mortality occur within 6 months after transplantation, so proper prophylaxis and treatment in this period may improve the prognosis of LT.

Keyword

Liver transplantation; Child; Bacterial infections; Korea

MeSH Terms

Anti-Bacterial Agents
Bacterial Infections*
Child*
Enterococcus
Humans
Immunosuppression
Incidence
Klebsiella
Korea
Liver Transplantation*
Liver*
Lung
Mortality
Peritoneum
Peritonitis
Pneumonia
Prevalence
Prognosis
Retrospective Studies
Sepsis
Staphylococcus aureus
Steroids
Tacrolimus
Transplants
Urinary Tract
Anti-Bacterial Agents
Steroids
Tacrolimus

Figure

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  Fig. 1 Number of deaths caused by bacterial infections.

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  Fig. 2 Proportion of gram-positive and gram-negative bacteria isolated from liver transplantation recipients, 2000 to 2015.

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