Program Schedule

463
Incidence of Candidemia In Pediatric Liver Transplant Patients

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background:

In adult liver transplant recipients, candidemia is of significant concern in the post transplant period. Prophylaxis is recommended in adult high-risk patients, such as those with prolonged operative time, retransplantation or high-volume transfusion requirement. There are limited data on the incidence of candidemia in pediatric liver transplant recipients. We aimed to describe the incidence of candidemia in the 30 days post-liver transplant and frequency of perioperative antifungal therapy at a large pediatric institution. 

Methods:

All liver transplant patients from 2000 to 2011 at the Children’s Hospital of Philadelphia were retrospectively reviewed. Data on perioperative antifungal therapy and blood culture results were collected. Patients were followed for 30 days post-transplant to evaluate for the onset of candidemia. 

Results:

134 patients underwent liver transplantation over the 12-year study period. Candidemia was diagnosed in the first 30 days post transplant in 10 (7.1%) patients. Rates of candidemia varied with each three-year period with the lowest rate being in the last three years of the study (Table). Perioperative antifungal therapy was infrequently used.  Rates increased between the periods of 2000 to 2002 and 2003 to 2005 but then remained stable (Table). 

Conclusion:

The incidence of candidemia among pediatric liver transplant patients appears to have decreased over time in this single center cohort. The overall rate of perioperative antifungal therapy remained low and did not increase in accordance with the decrease in candidemia. Further investigation in multicenter cohorts is warranted to determine sources for decreasing candidemia rates such as improved infection control practices and operating room factors.   

Table. Rates of candidemia and perioperative antifungal therapy by 3 year time periods

 

 

Liver transplant patients

Candidemia

 

(n, %)

Perioperative antifungal therapy

(n, %)

2000-02

30

2, 6.7%

2, 6.7%

2003-05

24

4, 16.6%

3, 12.5%

2006-08

35

3, 8.6%

4, 11.4%

2009-11

45

1, 2.2%

5, 11.1%

Total

134

10, 7.4%

14, 10.4%

Maia De Luca, M.D.1, Sarah B. Klieger, MPH2, Andreas Damianos, MD3, Michael Green, MD, MPH4, Theoklis Zaoutis, MD, MSCE5 and Brian T. Fisher, DO, MSCE6, (1)University Hospital Pediatric Department, Bambino Gesu' Children's Hospital, Rome, Italy, (2)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)The Children's Hospital of Philadelphia, Philadelphia, PA, (4)Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, (5)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, the Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Division of Infectious Diseases, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, Center for Clinical Epidemiology and Biostatistics, The Children’s Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Disclosures:

M. De Luca, None

S. B. Klieger, None

A. Damianos, None

M. Green, None

T. Zaoutis, Merck: Investigator, Research grant
Merck: Consultant, Consulting fee
Pfizer: Consultant, Consulting fee
Astellas: Consultant, Consulting fee

B. T. Fisher, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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