Hauschild Juliane, Bruns Nora, Lainka Elke, Dohna-Schwake Christian
Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
Department of Paediatrics II, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany.
Antibiotics (Basel). 2023 Feb 1;12(2):292. doi: 10.3390/antibiotics12020292.
(1) Background: Postoperative infections are major contributors of morbidity and mortality after paediatric liver transplantation (pLTX). Evidence and recommendations regarding the most effective antimicrobial strategy are lacking. (2) Results: Of 39 pLTX centres, 20 responded. Aminopenicillins plus ß-lactamase inhibitors were used by six (30%) and third generation cephalosporins by three (15%), with the remaining centres reporting heterogenous regimens. Broad-spectrum regimens were the standard in 10 (50%) of centres and less frequent in the 16 (80%) centres with an infectious disease specialist. The duration ranged mainly between 24-48 h and 3-5 days in the absence and 3-5 days or 6-10 days in the presence of risk factors. Strategies regarding antifungal, antiviral, adjunctive antimicrobial, and surveillance strategies varied widely. (3) Methods: This international multicentre survey endorsed by the European Liver Transplant Registry queried all European pLTX centres from the registry on their current practice of perioperative antibiotic prophylaxis and antimicrobial strategies via an online questionnaire. (4) Conclusions: This survey found great heterogeneity regarding all aspects of postoperative antimicrobial treatment, surveillance, and prevention of infections in European pLTX centres. Evidence-based recommendations are urgently needed to optimise antimicrobial strategies and reduce the spectrum and duration of antimicrobial exposure.
(1) 背景：术后感染是小儿肝移植（pLTX）后发病和死亡的主要原因。目前缺乏关于最有效抗菌策略的证据和建议。(2) 结果：39个小儿肝移植中心中，20个做出了回应。六个中心（30%）使用氨基青霉素加β-内酰胺酶抑制剂，三个中心（15%）使用第三代头孢菌素，其余中心报告的用药方案各异。广谱用药方案在10个（50%）中心是标准方案，在有传染病专科医生的16个（80%）中心使用频率较低。在无危险因素时，用药持续时间主要在24 - 48小时和3 - 5天之间，有危险因素时为3 - 5天或6 - 10天。抗真菌、抗病毒、辅助抗菌及监测策略各不相同。(3) 方法：这项由欧洲肝移植登记处认可的国际多中心调查，通过在线问卷向登记处的所有欧洲小儿肝移植中心询问其围手术期抗生素预防和抗菌策略的当前做法。(4) 结论：这项调查发现，欧洲小儿肝移植中心在术后抗菌治疗、监测及感染预防的各个方面存在很大差异。迫切需要基于证据的建议来优化抗菌策略，减少抗菌药物的使用范围和持续时间。
