儿童肝、肾移植受者的细菌和真菌感染性血流感染。

Bacterial and fungal bloodstream infections in pediatric liver and kidney transplant recipients.

机构信息

Viro-immunology Research Unit, Department of Infectious Diseases 8632, Rigshospitalet, University of Copenhagen, Blegdamsvej 9B, DK-2100, Copenhagen Ø, Denmark.

Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

出版信息

BMC Infect Dis. 2021 Jun 8;21(1):541. doi: 10.1186/s12879-021-06224-2.

DOI:10.1186/s12879-021-06224-2

PMID:34103013

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8188646/

Abstract

BACKGROUND

Bacterial and fungal bloodstream infections (BSI) are common after pediatric liver and kidney transplantations and associated with morbidity and mortality. However, knowledge about incidence rates, pathogen composition, and resistance patterns is limited. We aimed to describe the pattern of bacterial and fungal BSI in a cohort of pediatric liver and kidney transplant recipients.

METHODS

A prospective study of 85 pediatric liver and kidney transplant recipients transplanted from 2010 to 2017 with a total of 390 person-years of follow-up. Clinical characteristics and BSI were retrieved from national registries assuring nationwide follow-up for at least 1 year. BSI incidence rates and pathogen composition were investigated and stratified by the time post-transplantation and type of transplanted organ.

RESULTS

A total of 29 BSI were observed within the first 5 years post-transplantation with 16 different pathogens. The overall incidence rate of first BSI was 1.91 per 100 recipients per month (95% CI, 1.1-3.1) in the first year post-transplantation. The most common pathogens were Enterococcus faecium, Candida albicans, Escherichia coli, and Klebsiella pneumoniae. The pathogen composition depended on the transplanted organ with a higher proportion of BSI with Enterobacterales in kidney transplant recipients than in liver transplant recipients (67% vs. 20%, p = 0.03), while multiple pathogens were detected in the liver transplant recipients.

CONCLUSIONS

BSI were common in pediatric liver and kidney transplant recipients and the pathogen composition differed between liver and kidney transplant recipients. Guidelines for empiric antibiotic therapy should consider the type of transplanted organ as well as the local resistance patterns.

摘要

背景

儿童肝、肾移植术后常发生细菌和真菌血流感染（BSI），与发病率和死亡率相关。然而，有关发病率、病原体组成和耐药模式的知识有限。我们旨在描述一组儿童肝、肾移植受者中细菌和真菌 BSI 的模式。

方法

对 2010 年至 2017 年间接受肝、肾联合移植的 85 例儿童进行前瞻性研究，共随访 390 人年。从国家登记处获取临床特征和 BSI 数据，以确保至少 1 年的全国随访。按移植后时间和移植器官类型对 BSI 发生率和病原体组成进行调查和分层。

结果

在移植后 5 年内共观察到 29 例 BSI，涉及 16 种不同病原体。移植后第 1 年，首次 BSI 的总发生率为每 100 名受者每月 1.91 例（95%CI，1.1-3.1）。最常见的病原体为屎肠球菌、白假丝酵母菌、大肠埃希菌和肺炎克雷伯菌。病原体组成取决于移植器官，肾移植受者中肠杆菌属 BSI 的比例高于肝移植受者（67% vs. 20%，p=0.03），而肝移植受者中则检测到多种病原体。