Bloodstream Infections in Children Following Solid Organ Transplantation

Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
  • IDWeek Poster_BSI in SOT_10-14-16.pdf (293.9 kB)
  • Background: Infections in the early period following solid organ transplantation (SOT) are associated with substantial morbidity and mortality. The epidemiology of bloodstream infections (BSI) in children following SOT has not been well described. The objective of this study is to describe the incidence, timing, and microbiologic distribution of BSIs in children who have undergone SOT.

    Methods: We conducted a retrospective cohort study of children < 19 years of age who underwent SOT at the Children’s Hospital of Philadelphia between 2000 and 2013. Patients were followed for 180 days after transplantation or until death. Demographics, transplant information, and blood culture data were systematically collected from all SOT patients through structured chart review. Subsequent positive cultures with the same organism from the same patient within 30 days and polymicrobial infections were excluded.

    Results: Among the 613 children who underwent SOT in the 13 year time period (145 heart, 46 lung, 170 liver, and 252 kidney transplant recipients), 135 BSI episodes were identified. The incidence rate of BSI was highest for lung (2.8 episodes per 1000 patient-days) and heart (2.64 per 1000 patient-days) recipients, followed by liver (1.2 per 1000 patient-days) and was lowest among kidney recipients (0.38 per 1000 patient days). The median time from transplantation to first BSI was 11 days overall: 8 days for heart, 19 days for lung, 12.5 days for liver, and 79 days for kidney recipients. Gram positive bacteria accounted for 88/135 (65%) of BSIs: 62 (46%) were due to coagulase-negative staphylococci, 13 (9.6%) were due to Enterococcus species, and 5 (3.7%) were due to Staphylococcus aureus. Gram negative bacteria accounted for 35 (25.9%) BSIs: 12 (8.9%) Pseudomonas aeruginosa, 6 (4.4%) Enterobacter species, and 4 (3%) due to Escherichia coli. Candidemia accounted for 9 (6.7%) BSIs.

    Conclusion: The timing, frequency, and epidemiology of BSI varied across organ type. BSIs were more frequent and occurred earlier after transplant among lung and heart recipients. As BSIs have significant potential morbidity for the patient and the donor organ, these data can be leveraged to inform organ specific interventions to reduce and manage BSI.

    Figure: Distribution of bloodstream pathogens, by time after transplant

    Rana F. Hamdy, MD, MPH1, Ella Magun, BA2, Shikha Saxena, BA, BS2,3, Ana Maria Cardenas, PhD, D(ABMM)4,5 and Brian T. Fisher, DO, MSCE, MPH6, (1)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Children's Hospital of Philadelphia, Philadelphia, PA, (3)University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, (4)Department of Pathology and Lab Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, (5)Department of Pathology and Lab Medicine, Perelman School of Medicine at the University of Pennsylvania, 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


    R. F. Hamdy, None

    E. Magun, None

    S. Saxena, None

    A. M. Cardenas, None

    B. T. Fisher, Merck & Co.: Investigator , Research grant
    Pfizer Inc.: Investigator , Research grant
    Ansun BioPharma: Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.