265. Identification of Solid Organ Transplant Antimicrobial Stewardship Opportunities in Pediatric Liver Transplant Patients.
Session: Poster Abstract Session: Pediatric Antimicrobial and Diagnostic Stewardship
Thursday, October 4, 2018
Room: S Poster Hall
  • Liver transplant poster_IDweek 2018_Final.pdf (455.9 kB)
  • Background: Through the prospective audit with feedback program, post-operative antimicrobial use for pediatric liver transplant was observed to extend beyond the recommended 24 hours for surgical site infection (SSI) prophylaxis. Bacterial infections in the immediate post-transplant period represent significant risk in pediatric liver-transplant recipients, including SSI. We describe our post-transplant antimicrobial (PTA) utilization in the largest pediatric liver transplant center to determine opportunities for the antimicrobial stewardship program (ASP).

    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.

    Laura Bio, PharmD, BCPS, Pharmacy, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, Hayden Schwenk, MD, Pediatric Infectious Diseases, Stanford University School of Medicine, Stanford, CA, Sharon F. Chen, MD, MS, Pediatrics, Stanford University, Stanford, CA and Hayley A. Gans, MD, FPIDS, Stanford University School of Medicine, Stanford University Medical Center, Stanford, CA


    L. Bio, None

    H. Schwenk, None

    S. F. Chen, None

    H. A. Gans, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.