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Bloodstream Infections During the First Year After Pediatric Small Bowel Transplantation

Florescu, Diana F. MD*; Qiu, Fang MS, PhD; Langnas, Alan N. DO; Mercer, David F. MD; Chambers, Heather APRN*; Hill, Lisa A. APRN*; Qaragholi, Noor; Kalil, Andre C. MD, MPH*

The Pediatric Infectious Disease Journal: July 2012 - Volume 31 - Issue 7 - p 700–704
doi: 10.1097/INF.0b013e318256f9c3
Original Studies

Background: Little information regarding bloodstream infections (BSIs) in small bowel transplantation has been published.

Methods: We reviewed the medical records of 98 pediatric patients who underwent small bowel transplantation. Patients’ characteristics were analyzed with Wilcoxon rank-sum, χ2 or Fisher’s exact tests. We estimated the overall survival by the Kaplan-Meier method and compared survival distributions between groups with the log-rank test.

Results: Sixty-eight patients developed ≥1episode of BSIs (total of 146 episodes), and 69.1% of the first infections were diagnosed in the 3 months post-transplantation. The most common sources of infection were as follows: central venous catheters (49.3%) and intra-abdominal infections (32.9%). Central venous catheters were present in 86.3%, and total parenteral nutrition within 7 days before infection was administered in 72.6% of episodes. 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 coagulase-negative Staphylococcus (40 isolates). Patients with infections were younger than those without (median 1.4 versus 2.1 years, P = 0.02). Four grafts were lost after transplantation 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% confidence interval: 68.3%–94.8%) versus 72.1% in patients with BSIs (95% confidence interval: 59.8%–81.2%). Overall time to death was shorter in patients with BSIs than in patients without BSIs (P = 0.056).

Conclusions: Almost 70% of small bowel transplantation recipients developed BSIs, mainly in the early months after transplantation. BSIs were mainly from a central venous catheter or intra-abdominal source. Enterococcus spp were the most frequently isolated organisms. Patients with BSIs had worse survival than patients with BSIs.

Supplemental Digital Content is available in the text.

From the *Infectious Diseases Section, Biostatistics Department, and Transplant Surgery Department, University of Nebraska Medical Center, Omaha, NE.

Accepted for publication March 1, 2012.

The authors have no conflicts of interest or funding to disclose.

Address for correspondence: Diana F. Florescu, MD, Transplant Infectious Diseases Program, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400. E-mail:

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© 2012 Lippincott Williams & Wilkins, Inc.