ZHANG Zheng-zheng, TAO Jin-hao, YAN Gang-feng, CHENG Ye, CAI Xiao-di, CHEN Yang, XIE Xin-bao, CHEN Gong, LU Guo-ping, CHEN Wei-ming, SHEN Cong-huan
Objective To investigate the incidence of earlyinfection in children after liver transplantation in a pediatric intensive care unit and analyze the ralated factors of infection.Methods This retrospective study was conducted at Children's Hospital of Fudan University from Jan 1, 2014 to Dec 9,2019. The pathogen detection rate, species,infection site and drug resistance were analyzed. The cases were divided into infected group and the non-infected group,and the related factors of infection were analyzed.Results During the study period,a total of 70 children received liver transplants. According to the inclusion criteria,31 cases (44.3%) were infected after liver transplantation,of which 27 cases (87.1%) had positive microbial culture.A total of 131 pathogens were isolated. Among them,61 strains (46.6%) were from the lower respiratory tract (deep sputum and bronchoalveolar lavage fluid),39 strains (29.8%) from abdominal drainage,21 strains (16.0%) from bloodstream, and 10 strains (7.6%) from the urinary tract. Mixed infection was more common.Cases whose infections involved two or more sites accounted for 45.0%. Gram-negative bacteria,gram-positive bacteria and fungi accounted for 67.1%,11.5% and 27.4%,respectively.The top three bacteria were 33 strains (25.2%) of Acinetobacter baumannii,9 strains (6.9%) of Streptomonas maltophilia,and 8 strains (6.1%) of Pseudomonas aeruginosa.Among them, Acinetobacter baumannii and Pseudomonas aeruginosa were multi-drug resistant strains. Candida albicans was the main fungal infection,which were 26 strains (19.9%) and were susceptible to fluconazole. According to the site of infection,the pathogen of the lower respiratory tract and bloodstream infection was mainly Acinetobacter baumannii,the pathogen of abdominal infection was mainly Pseudomonas,and the pathogen of urinary tract infection was mainly Candida albicans. In the infection group,the median operative time was 9 hours (P=0.038),the median PICU stay was 7 days (P=0.017),the median CVC was 8 days (P=0.013),and the highest concentration of tacrolimus was 15.9 ng/mL (P=0.014).There were significant differences between the infected group and the non-infected group. Logistic correlation analysis showed that age less than 1 year (OR=4.37,95%CI:1.03-18.6,P=0.046) was related to postoperative infection.Conclusion The incidence of early infections in children after liver transplantation in the hospital in recent years was high,and the respiratory and abdomen were the main sites of infection. The gram-negative bacilli and Candida albicans were the main pathogens,among which gram-negative bacilli were multi-drug resistant.Factors associated with early infection after transplantation may be related to the age (less than 1 year old),long operation time, long CVC indwelling time, long PICU stay, and high tacrolimus concentration.
