Methods: All children who underwent a liver transplant between 1/1/17 and 9/30/17 at our institution were included. Antimicrobials initiated within 14 days post-transplant were captured, presence of fever within 14 days, positive microbiologic data within 30 days, and massive transfusion protocol (MTP) status were collected. The primary endpoint was duration of PTA. Clinical factors associated with PTA use > 48 hours were evaluated.
Results: Thirty-eight children underwent a liver transplant during the study period and 29 (76%) received a broad-spectrum gram-negative (GN) antibiotic for > 48 hours post-transplant. Half of the patients received vancomycin and 15 (40%) received an antifungal post-transplant. Fever occurred in 21 (55%) of patients with a median onset of 1 day; 3 (8%) patients had culture-proven post-transplant bacterial infection, with no resistant gram-positive organisms identified. Eight patients (21%) met MTP and received PTA for ≥ 7 days and none had a positive bacterial culture. No differences were detected in fever or culture proven post-transplant infection between patients who received ≤ 48 hours of GN antibiotics compared to those who received > 48 hours.
Conclusion: The majority of children received PTA beyond 48 hours which was not attributable to prolonged post-transplant fevers or positive cultures. We identified ASP opportunities including limiting GN antibiotics to 48 hours post-transplant, eliminating empiric vancomycin, restricting antifungals to MTP only, and limiting MTP PTA to 5 days.
S. F. Chen, None
H. A. Gans, None
See more of: Poster Abstract Session