Publication: High prevalence of multidrug-resistant gram-negative bacterial infection following pediatric liver transplantation
Issued Date
2020-11-06
Resource Type
ISSN
15365964
Other identifier(s)
2-s2.0-85095802885
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Medicine. Vol.99, No.45 (2020), e23169
Suggested Citation
Chanita Phichaphop, Nopporn Apiwattanakul, Chonnamet Techasaensiri, Chatmanee Lertudomphonwanit, Suporn Treepongkaruna, Chollasak Thirapattaraphan, Sophida Boonsathorn High prevalence of multidrug-resistant gram-negative bacterial infection following pediatric liver transplantation. Medicine. Vol.99, No.45 (2020), e23169. doi:10.1097/MD.0000000000023169 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/60028
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
High prevalence of multidrug-resistant gram-negative bacterial infection following pediatric liver transplantation
Other Contributor(s)
Abstract
Bacterial infection has been identified as one of the most significant complications of liver transplantation (LT). Multidrug-resistant (MDR) gram-negative bacteria (GNB) infection remains problematic issue following LT in the adults. However, data in children are scarce. We aimed to examine the prevalence and associated factors of MDR-GNB infection among pediatric LT recipients.We performed a single-center retrospectively study of 118 children who underwent LT between January 2010 and December 2018. Data on the prevalence, clinical characteristics, types, and sites of MDR-GNB infection within 3 months after LT as well as the treatment outcomes were collected. Multidrug resistance was defined as acquired non-susceptibility to at least 1 agent in 3 or more antibiotic classes.In total, 64 (53.7%) patients developed 96 episodes of culture-proven bacterial infection with 93 GNB isolates. Moreover, there were 58 (62.4%) MDR-GNB isolates, with a predominance of Klebsiella pneumoniae (32.7%), Escherichia coli (31%), and Pseudomonas aeruginosa (10.3%). Interestingly, 10 (17.2%) isolates were determined to be carbapenem-resistant Enterobacteriaceae. The median time to MDR-GNB infection was 9 (interquartile range: 5-33) days. The most common type of infection was intra-abdominal infection (47.9%). In the multivariate analysis, the significant variables associated with post-LT MDR-GNB infection include exposure to third-generation cephalosporins (hazard ratio [HR]: 2.16, P = .023), operative time (hazard ratio [HR] 1.20, P = .009), and length of intensive care unit stay (HR 1.03, P = .049). With a focus on carbapenem-resistant Enterobacteriaceae infection, a pediatric end-stage liver disease score >21 was the only significant 6 variable in the multivariate analysis (HR 11.48, P = .024). The overall 3-month mortality rate was 6.8%.This study has highlighted the high prevalence rate of MDR-GNB infection after pediatric LT. Therefore, caution on the emergence of MDR-GNB infection should be paid in at-risk children. Moreover, knowledge regarding the prevalence of MDR-GNB infection and resistant patterns is essential for guideline development to prevent and minimize the risk of MDR-GNB infection in this group of patients.