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

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BACKGROUND: Bacterial 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.

METHODS: A 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.

RESULTS: A 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.

CONCLUSIONS: BSI 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.

OriginalsprogEngelsk
Artikelnummer541
TidsskriftBMC Infectious Diseases
Vol/bind21
Udgave nummer1
ISSN1471-2334
DOI
StatusUdgivet - 8 jun. 2021

Bibliografisk note

Funding Information:
This work was supported by the Novo Nordic Foundation, the Independent Research Fund (FSS), the Danish National Research Foundation (DNRF) grant no. 126, and the Research Foundation of Rigshospitalet. The funding sources were not involved in any part of the study design, data collection, data analysis, and interpretation of the data or the writing of this manuscript.

Funding Information:
OR received a grant from The Research Foundation of Rigshospitalet; ADK received a grant from The Danish Heart Foundation and a traveling grant from Gilead not related to this work; NEW received a grant from The Research Foundation of Rigshospitalet; SDN received unrestricted research grants from Novo Nordisk Foundation and Independent Research Fund (FSS) and traveling grants from Gilead and Merck not related to this work; DLM, SSS, JDK, and AR reported no conflict of interest.

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