Dohna Schwake Christian, Guiddir Tamazoust, Cuzon Gaelle, Benissa Mohamed-Rida, Dubois Cécile, Miatello Jordi, Merchaoui Zied, Durand Philippe, Tissieres Pierre
Pediatric Intensive Care, Paris South University Hospitals AP-HP, Le Kremlin Bicêtre, France.
Pediatric Intensive Care, Universitätsmedizin Essen, Essen, Germany.
Transpl Infect Dis. 2020 Feb;22(1):e13208. doi: 10.1111/tid.13208. Epub 2019 Dec 9.
Infectious complications after pediatric liver transplantation frequently occur and are potentially serious. Data concerning strictly defined bacterial infections and their associated risk factors are lacking.
For the pediatric liver transplant postoperative period, we analyzed data from the nosocomial infection surveillance (2006-2015).
A total of 235 bacterial infections in 162 transplantations (47%) occurred, including 32 bacterial pneumonia cases, 104 surgical site infections, 27 urinary tract infections, and 40 bloodstream infections. Sepsis was diagnosed in 127 cases (54%), severe sepsis in 22 (9%) cases, and septic shock in 41 (17%) cases. Thirty patients (9%) died, and septic shock was the leading cause of death. The carrier status of multi-drug resistant bacteria and a tacrolimus level >20 ng/mL were independent risk factors for surgical site infections and the occurrence of severe sepsis or septic shock. The length of mechanical ventilation was an independent risk factor for pneumonia and surgical site infection.
Bacterial infections in the early postoperative period after pediatric liver transplantation are associated with high morbidity and mortality. Physicians involved in the medical care of these patients should be aware of the specific risk factors, and further development of prevention programs is highly recommended.
小儿肝移植术后感染并发症频繁发生且可能很严重。目前缺乏关于严格定义的细菌感染及其相关危险因素的数据。
针对小儿肝移植术后时期，我们分析了医院感染监测（2006 - 2015年）的数据。
162例移植手术中共发生235例细菌感染（47%），包括32例细菌性肺炎、104例手术部位感染、27例尿路感染和40例血流感染。127例（54%）诊断为脓毒症，22例（9%）为严重脓毒症，41例（17%）为感染性休克。30例（9%）患者死亡，感染性休克是主要死因。多重耐药菌携带状态和他克莫司水平>20 ng/mL是手术部位感染以及发生严重脓毒症或感染性休克的独立危险因素。机械通气时间是肺炎和手术部位感染的独立危险因素。
小儿肝移植术后早期细菌感染与高发病率和死亡率相关。参与这些患者医疗护理的医生应了解具体危险因素，强烈建议进一步制定预防方案。
