TY - JOUR
T1 - Severe Sepsis in Pediatric Liver Transplant Patients
T2 - The Emergence of Multidrug-Resistant Organisms
AU - Alcamo, Alicia M.
AU - Alessi, Lauren J.
AU - Vehovic, S. Noona
AU - Bansal, Neha
AU - Bond, Geoffrey J.
AU - Carcillo, Joseph A.
AU - Green, Michael
AU - Michaels, Marian G.
AU - Aneja, Rajesh K.
N1 - Funding Information:
Supported, in part, by grant from National Institutes of Health (NIH) T32-HD40686 (to Dr. Alcamo) and NIH R01-GM108618 (to Dr. Carcillo).
Funding Information:
Dr. Alcamo’s institution received funding from National Institutes of Health he Sepsis Prevalence, Outcomes, and Therapies study, port for article research from the NIH. Dr. Carcillo’s institution received (NIH) T32 HD040686. Drs. Alcamo, Carcillo, and Aneja received sup- a prospective cross-sectional study of approximately funding from the NIH/National Institute of General Medical Sciences. Dr. T7,000 children in 26 countries, reported a severe sepsis Michaels’ institution received funding from Pfizer (unrelated study grant), prevalence rate of 8.2% and a mortality of 25%. Similar to member (travel and room for meetings, no honoraria) and from National and she received funding as an American Society of Transplantation board other studies, children with comorbid conditions were noted Institute of Allergy and Infectious Diseases (honoraria and travel and room to have a higher mortality than previously healthy children, ties from UpToDate. The remaining authors have disclosed that they do for Data and Safety Monitoring Board meetings). Dr. Aneja received royal- for example, children with solid organ or stem cell transplant not have any potential conflicts of interest. had a mortality of 48.2% (1). Based on data retrieved from the For information regarding this article, E-mail: Alicia.Alcamo@chp.edu Organ Procurement and Transplantation Network/Scientific
Funding Information:
1Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. 2Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. 3Division of Pediatric Cardiology, Department of Pediatrics, Children’s Hospital of Montefiore, Bronx, NY. 4Departments of Transplant Surgery and General and Thoracic Pediatric Surgery, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA. Supported, in part, by grant from National Institutes of Health (NIH) T32-HD40686 (to Dr. Alcamo) and NIH R01-GM108618 (to Dr. Carcillo).
Publisher Copyright:
© 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Objectives: To describe characteristics of liver transplant patients with severe sepsis in the PICU. Design: Retrospective descriptive analysis. Setting: Tertiary children's hospital PICU. Patients: Liver transplant recipients admitted January 2010 to July 2016 for pediatric severe sepsis. Interventions: None. Measurements and Main Results: Between January 2010 and July 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 years (1-6.5 yr), 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 days (8.25-39.75 d) and 25 days (9-41 d), whereas 54.5 days (17-131.25 d) for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms accounted for 47.6% of bacterial sepsis. Vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producers were the most frequently identified multidrug-resistant organisms. Patients with multidrug-resistant organism sepsis demonstrated higher admission Pediatric Logistic Organ Dysfunction scores (p = 0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and multiple organ dysfunction syndrome, respectively (p = 0.047 and p = 0.044). Overall mortality was 5.5% (n = 2 patients), with both deaths occurring in multidrug-resistant organism episodes. Conclusions: We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
AB - Objectives: To describe characteristics of liver transplant patients with severe sepsis in the PICU. Design: Retrospective descriptive analysis. Setting: Tertiary children's hospital PICU. Patients: Liver transplant recipients admitted January 2010 to July 2016 for pediatric severe sepsis. Interventions: None. Measurements and Main Results: Between January 2010 and July 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 years (1-6.5 yr), 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 days (8.25-39.75 d) and 25 days (9-41 d), whereas 54.5 days (17-131.25 d) for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms accounted for 47.6% of bacterial sepsis. Vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producers were the most frequently identified multidrug-resistant organisms. Patients with multidrug-resistant organism sepsis demonstrated higher admission Pediatric Logistic Organ Dysfunction scores (p = 0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and multiple organ dysfunction syndrome, respectively (p = 0.047 and p = 0.044). Overall mortality was 5.5% (n = 2 patients), with both deaths occurring in multidrug-resistant organism episodes. Conclusions: We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
KW - multidrug-resistant organisms
KW - pediatric liver transplantation
KW - pediatric severe sepsis
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U2 - 10.1097/PCC.0000000000001983
DO - 10.1097/PCC.0000000000001983
M3 - Article
C2 - 31094887
AN - SCOPUS:85069273581
SN - 1529-7535
VL - 20
SP - e326-e332
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 7
ER -