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Abstract O-34: MULTI-DRUG RESISTANT ORGANISM SEPSIS IN PEDIATRIC MULTI-VISCERAL AND ISOLATED BOWEL TRANSPLANT RECIPIENTS AN INTRODUCTORY, PILOT STUDY

Alcamo, A.1; Trivedi, M.2; Dulabon, C.3; Bond, G.4; Carcillo, J.1; Marian, M.2; Aneja, R.1

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 15
doi: 10.1097/01.pcc.0000537376.95011.9b
Oral Abstracts
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1Childrens Hospital of UPMC, Critical Care Medicine, Pittsburgh, USA

2Childrens Hospital of UPMC, Pediatrics, Pittsburgh, USA

3Akron Children’s Hospital, Hospital Medicine, Akron, USA

4Childrens Hospital of UPMC, Transplant Surgery and General and Thoracic Pediatric Surgery, Pittsburgh, USA

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Aims & Objectives:

Infections are the leading cause of death in transplant recipients, but there is a paucity of pediatric data. Recently, we demonstrated that 47% of bacterial infections in septic pediatric liver transplant recipients could be attributed to multi-drug resistant organisms (MDROs). We now aim to describe the epidemiological landscape of multi-visceral (MVTx) and isolated bowel transplant (BTx) patients admitted with severe sepsis (PSS) to the pediatric intensive care unit (PICU).

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Methods

IRB-approved, retrospective analysis of MV & BTx transplanted between 7/2011 and 12/2015 with subsequent PSS admissions until 1/2017. PSS defined by international pediatric sepsis consensus conference criteria. MDROs defined as bacteria resistant to greater than one class of antimicrobial agents.

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Results

24 patients received an MV or BTx during the study period (16 MVTx, 8 BTx). 54.2% (n=13) were subsequently admitted with PSS for a total of 24 episodes. Table 1 shows demographics for PSS patients. Figure 1 identifies etiology of infections. Overall 47.8% of infections were bacterial, with 81.8% of those infections secondary to MDROs (vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producing organisms most common). Bloodstream infections were most common site for bacterial infections (45.5%) with the remainder peritonitis/cholangitis or wound infections. Outcome measures shown in Table 2. Mortality was 7.7% (n=1). Median PICU and hospital LOS was 5.5 days (IQR: 2–16.25) and 63.5 days (IQR: 21.75–131).

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Conclusions

Despite a high prevalence of MDRO infections resulting in sepsis, mortality rates are comparable to non-transplant patients. Multi-center studies are needed to better understand the impact of these infections and identify pathways for risk mitigation.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies