Rhee K W, Oh S H, Kim K M, Kim D Y, Lee Y J, Kim T, Kim M-N
Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Songpa-Gu, Seoul, Korea.
Transplant Proc. 2012 Apr;44(3):794-6. doi: 10.1016/j.transproceed.2012.01.014.
To determine the perioperative risk factors for bacterial infections after pediatric living donor liver transplantation (LDLT), we investigated the clinical profiles of 149 children who underwent pediatric LDLT between 1994 and 2008. Bacterial infections were diagnosed based on guidelines proposed by the Centers for Disease Control. We observed 36 bloodstream infections (BSIs) in 32/149 (21.5%) patients (0.24 infections per patient), which, 21 (58.3%) BSIs in 19 patients were due to gram-positive and 15 (41.7%) in 13 patients to gram-negative organisms. The most common pathogens of early BSI were coagulase-negative Staphylococcus; (n = 11; 30.6%) and Klebsiella pneumoniae (n = 8; 22.2%). The most common site of early BSI was catheter-related (n = 14; 38.9%). Multivariate analysis showed that age ≤ 1 year (P < .05; odds ratio [OR] = 3.90; 95% CI, 1.83-15.26) and bile duct complications (P < .05; OR = 6.2, 95% CI = 3.21-35.23) were significant independent risk factors for early BSIs. More cautious management of pediatric LDLTs may be necessary for younger age children particularly with postoperative biliary complications.
为了确定小儿活体肝移植（LDLT）术后细菌感染的围手术期危险因素，我们调查了1994年至2008年间接受小儿LDLT的149名儿童的临床资料。细菌感染根据疾病控制中心提出的指南进行诊断。我们在149例患者中的32例（21.5%）观察到36例血流感染（BSI）（每位患者0.24次感染），其中19例患者的21例（58.3%）BSI由革兰氏阳性菌引起，13例患者的15例（41.7%）由革兰氏阴性菌引起。早期BSI最常见的病原体是凝固酶阴性葡萄球菌（n = 11；30.6%）和肺炎克雷伯菌（n = 8；22.2%）。早期BSI最常见的部位是导管相关部位（n = 14；38.9%）。多因素分析显示，年龄≤1岁（P <.05；比值比[OR]=3.90；95%可信区间，1.83 - 15.26）和胆管并发症（P <.05；OR = 6.2，95%可信区间 = 3.21 - 35.23）是早期BSI的重要独立危险因素。对于年龄较小特别是有术后胆道并发症的儿童，可能需要更谨慎地管理小儿LDLT。
