Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA.
Pediatr Crit Care Med. 2019 Jul;20(7):e326-e332. doi: 10.1097/PCC.0000000000001983.
To describe characteristics of liver transplant patients with severe sepsis in the PICU.
Retrospective descriptive analysis.
Tertiary children's hospital PICU.
Liver transplant recipients admitted January 2010 to July 2016 for pediatric severe sepsis.
None.
Between January 2010 and July 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 years (1-6.5 yr), 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 days (8.25-39.75 d) and 25 days (9-41 d), whereas 54.5 days (17-131.25 d) for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms accounted for 47.6% of bacterial sepsis. Vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase producers were the most frequently identified multidrug-resistant organisms. Patients with multidrug-resistant organism sepsis demonstrated higher admission Pediatric Logistic Organ Dysfunction scores (p = 0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and multiple organ dysfunction syndrome, respectively (p = 0.047 and p = 0.044). Overall mortality was 5.5% (n = 2 patients), with both deaths occurring in multidrug-resistant organism episodes.
We report that multidrug-resistant organisms are increasingly being identified as causative pathogens for sepsis in pediatric liver transplant recipients and are associated with significantly higher odds for mechanical ventilation and higher organ failure. The emergence of multidrug-resistant organism infections in pediatric liver transplant patients has implications for patient outcomes, antibiotic stewardship, and infection prevention strategies.
描述 PICU 中肝移植患者严重脓毒症的特征。
回顾性描述性分析。
三级儿童医院 PICU。
2010 年 1 月至 2016 年 7 月期间因小儿严重脓毒症入院的肝移植受者。
无。
2010 年 1 月至 2016 年 7 月期间，共进行了 173 例肝移植，其中 36 例（21%）患者因严重脓毒症入院（共 54 例）。入院时的中位年龄为 2 岁（1-6.5 岁），47.2%为男性。细菌感染最为常见（77.8%），其次是培养阴性（12.9%）和病毒感染（7.4%）。真菌感染仅占 1.9%。病毒和培养阴性感染的中位移植时间分别为 18 天（8.25-39.75 天）和 25 天（9-41 天），而细菌感染为 54.5 天（17-131.25 天）。血流和腹腔内是最常见的细菌部位（分别为 45%和 22.5%）。多重耐药菌占细菌脓毒症的 47.6%。万古霉素耐药肠球菌和超广谱β-内酰胺酶生产者是最常鉴定出的多重耐药菌。患有多重耐药菌脓毒症的患者表现出更高的入院儿科逻辑器官功能障碍评分（p=0.043），并表现出机械通气和多器官功能障碍综合征的优势比分别为 3.8 和 3.6（p=0.047 和 p=0.044）。总体死亡率为 5.5%（n=2 例），均发生在多重耐药菌感染中。
我们报告称，多重耐药菌越来越被认为是小儿肝移植受者脓毒症的病原体，并与机械通气和更高器官衰竭的可能性显著增加相关。儿科肝移植患者出现多重耐药菌感染对患者结局、抗生素管理和感染预防策略都有影响。
