Onyearugbulem Chinyere, Williams Lauren, Zhu Huirong, Gazzaneo Maria C, Melicoff Ernestina, Das Shailendra, Coss-Bu Jorge, Lam Fong, Mallory George, Munoz Flor M
Texas Children's Hospital, Houston, Texas.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Transpl Infect Dis. 2018 Dec;20(6):e13000. doi: 10.1111/tid.13000. Epub 2018 Oct 5.
Although infection is the leading cause of death in the first year following pediatric lung transplantation, there are limited data on risk factors for early infection. Sepsis remains under-recognized and under-reported in the early post-operative period for lung transplant recipients (LTR). We evaluated the incidence of infection and sepsis, and identified risk factors for infection in the early post-operative period in pediatric LTRs. A retrospective review of medical records of LTRs at a large quaternary-care hospital from January 2009 to March 2016 was conducted. Microbiology results on days 0-7 after transplant were obtained. Sepsis was defined using the 2005 International Pediatric Consensus Conferencecriteria. Risk factors included history of recipient and donor infection, history of multi-drug resistant (MDR) infection, nutritional status, and surgical times. Among the 98 LTRs, there were 22 (22%) with post-operative infection. Prolonged donor ischemic time ≥7 hours, cardiopulmonary bypass(CPB) time ≥340 minutes, history of MDR infection and diagnosis of cystic fibrosis were significantly associated with infection. With multivariable regression analysis, only prolonged donor ischemic time remained significant (OR 4.4, 95% CI: 1.34-14.48). Further research is needed to determine whether processes to reduce donor ischemic time could result in decreased post-transplant morbidity.
尽管感染是小儿肺移植术后第一年的主要死亡原因，但关于早期感染危险因素的数据有限。在肺移植受者（LTR）术后早期，脓毒症仍未得到充分认识和报告。我们评估了小儿LTR术后早期感染和脓毒症的发生率，并确定了感染的危险因素。对一家大型四级护理医院2009年1月至2016年3月期间LTR的病历进行了回顾性研究。获取了移植后0至7天的微生物学结果。脓毒症采用2005年国际儿科学会共识会议标准进行定义。危险因素包括受者和供者感染史、多重耐药（MDR）感染史、营养状况和手术时间。在98例LTR中，有22例（22%）发生术后感染。供者缺血时间延长≥7小时、体外循环（CPB）时间≥340分钟、MDR感染史和囊性纤维化诊断与感染显著相关。通过多变量回归分析，只有供者缺血时间延长仍具有显著性（OR 4.4，95%CI：1.34 - 14.48）。需要进一步研究以确定减少供者缺血时间的措施是否会降低移植后发病率。
