Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA; Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
Division of Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
J Heart Lung Transplant. 2017 Sep;36(9):996-1003. doi: 10.1016/j.healun.2017.05.009. Epub 2017 May 11.
Bacterial infections represent a major cause of morbidity and mortality in heart transplant recipients. However, data describing the epidemiology and outcomes of these infections in children are limited.
We analyzed the Pediatric Heart Transplant Study database of patients transplanted between 1993 and 2014 to determine the etiologies, risk factors and outcomes of children with bacterial infections post-heart transplantation.
Of 4,458 primary transplants in the database, there were 4,815 infections that required hospitalization or intravenous therapy, 2,047 (42.51%) of which were bacterial. The risk of bacterial infection was highest in the first month post-transplant, and the bloodstream was the most common site (24.82%). In the early post-transplant period (<30 days post-transplant), coagulase-negative staphylococci were the most common pathogens (16.97%), followed by Enterobacter sp (11.99%) and Pseudomonas sp (11.62%). In the late post-transplant period, community-acquired pathogens Streptococcus pneumoniae (6.27%) and Haemophilus influenzae (2.82%) were also commonly identified. Patients' characteristics independently associated with acquisition of bacterial infection included younger age (p < 0.0001) and ventilator (p < 0.0001) or extracorporeal membrane oxygenation (p = 0.03) use at time of transplant. Overall mortality post-bacterial infection was 33.78%, and previous cardiac surgery (p < 0.001) and multiple sites of infection (p = 0.004) were independent predictors of death.
Bacteria were the most common causes of severe infections in pediatric heart transplant recipients and were associated with high mortality rates. The risk of acquiring a bacterial infection was highest in the first month post-transplant, and a large proportion of the infections were caused by multidrug-resistant pathogens.
细菌感染是心脏移植受者发病率和死亡率的主要原因。然而，描述这些感染在儿童中的流行病学和结局的数据有限。
我们分析了 1993 年至 2014 年间接受心脏移植的患者的儿科心脏移植研究数据库，以确定儿童心脏移植后发生细菌感染的病因、危险因素和结局。
在数据库中的 4458 例原发性移植中，有 4815 例感染需要住院或静脉治疗，其中 2047 例（42.51%）为细菌感染。移植后第一个月发生细菌感染的风险最高，血流是最常见的感染部位（24.82%）。在移植后早期（<30 天），凝固酶阴性葡萄球菌是最常见的病原体（16.97%），其次是肠杆菌属（11.99%）和假单胞菌属（11.62%）。在移植后晚期，社区获得性病原体肺炎链球菌（6.27%）和流感嗜血杆菌（2.82%）也经常被发现。与细菌感染发生相关的患者特征包括年龄较小（p<0.0001）和移植时使用呼吸机（p<0.0001）或体外膜氧合（p=0.03）。细菌感染后的总体死亡率为 33.78%，既往心脏手术（p<0.001）和多处感染（p=0.004）是死亡的独立预测因素。
细菌是儿童心脏移植受者严重感染的最常见原因，与高死亡率相关。移植后第一个月发生细菌感染的风险最高，且很大一部分感染由多药耐药病原体引起。
