title: Infection and associated risk factors in the immediate postoperative period of pediatric liver transplantation: a study of 176 transplants.
abstract: OBJECTIVE
  To describe the characteristics of infections occurring in the immediate postoperative period of orthotopic liver transplantation (OLT) in children in a pediatric intensive care unit (PICU) and the associated risk factors.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Multidisciplinary 16-bed pediatric intensive care unit in a tertiary university hospital.
  
  
  METHODS
  One hundred and thirty-three pediatric patients (range 6M to 22 yr) who underwent 176 liver transplantations and were admitted to the pediatric intensive care unit for at least 48 h.
  
  
  RESULTS
  A total of 180 infectious episodes (IE) occurred in 78 (59%) patients who underwent 96 (54.5%) liver transplantations (1.35 IE/patient; 1.02 IE/transplantation). The mean stay was 15.4 +/- 1.1 d (mean +/- SD) and 22 patients died in the pediatric intensive care unit. One hundred and thirty-one IE (72.8%) were bacterial, 31 (17.2%) fungal, and 14 (7.8%) mixed bacterial and fungal. 39% of the IE appeared in the first postoperative week and 27% in the second postoperative week. The most common sites of infection were abdomen (48.3%) and blood stream (26.1%). Bacteria, alone or with fungi, were present in 145 IE (1.1 IE/patient). Gram-positive aerobic bacteria (63%) predominated over gram-negative bacteria (54%) and fungi. Fungi were present in 45 IE; 53.4% of the infections occurred in lung (73% yeasts). The risk factors for infection that were identified were related with younger age, lower body weight, longer cold ischemia time, partial graft, and the volume of packed red blood cell transfusions. Infected patients had more postoperative complications and longer stay in the PICU (21 +/- 16 vs. 8 +/- 6 d), but no increase in mortality. The risk of infection increased 2.38 times with partial grafts and 1.1 times with each intraoperative transfusion of 20 ml/kg of packed red blood cells (RBC).
  
  
  CONCLUSIONS
  Infection in the immediate postoperative period of pediatric OLT was related with a high morbidity but was not related significantly with increased mortality. The main risk factors for infection in the postoperative period of OLT were related essentially with small recipient size and the inherent complexity of the operation. Routine oropharyngeal decontamination is recommended, as well as early administration of oral nystatin in preoperative intestinal decontamination. The risk of infection increased 2.38 times with partial grafts and 1.1 times with the transfusion of every 20 ml of packed RBC.
authors.affiliation: Pediatric Intensive Care Unit, La Paz Children's Hospital, Madrid, Spain.
authors.forename: S
authors.initials: S
authors.lastname: García
authors.forename: J
authors.initials: J
authors.lastname: Roque
authors.forename: F
authors.initials: F
authors.lastname: Ruza
authors.forename: M
authors.initials: M
authors.lastname: González
authors.forename: R
authors.initials: R
authors.lastname: Madero
authors.forename: F
authors.initials: F
authors.lastname: Alvarado
authors.forename: R
authors.initials: R
authors.lastname: Herruzo
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D009181:Mycoses / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D014777:Virus Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control