Bacteremia after intestinal transplantation in children correlates temporally with rejection or gastrointestinal lymphoproliferative disease.
BACKGROUND
Bacteremia occurs frequently after intestinal transplantation (ITx) in children. During our initial experience with this procedure, we noted that bacteremic episodes tended to occur simultaneously with the presence of rejection and/or gastrointestinal (GI) posttransplant lymphoproliferative disease (PTLD).


OBJECTIVE
To document the association of bacteremia with rejection and GI PTLD in pediatric ITx recipients.


METHODS
Retrospective analysis of all medical records from 62 children who underwent ITx between July 1990 and January 1998 at Children's Hospital of Pittsburgh. A bacteremic episode was defined as two positive blood cultures from different sites at the same time or from the same site at different times. Rejection and PTLD were defined using previously published criteria.


RESULTS
A total of 39/62 ITx recipients had 133 blood stream infections (2.1 episodes/patient) including 121 episodes of bacteremia and 12 of fungemia. Enteric organisms were the most frequently recovered pathogens (Gram negative rods, n=76; enterococci, n=36). Enteric organisms were recovered as a single organism (n=57), with another enteric bacteria (n=23), or with coagulase negative staphylococci (CONS) (n=24). CONS were recovered as a single organism on 21 occasions. An obvious source of bacteremia was not found for 115/121 episodes. Endoscopy was performed for 107 of the 115 bacteremia episodes; an abnormal histology was identified in 74 revealing rejection (n=36), GI PTLD (n=21), or both (n=17). When endoscopy showed GI pathology, enteric organisms alone or in combination with CONS were recovered on 63/107 occasions, although CONS were recovered alone only 11 times.


CONCLUSIONS
Bacteremia accompanies GI rejection and intestinal PTLD in ITx recipients. Endoscopy should be performed to inspect the allograft when bacteremia occurs without an obvious source in these patients. This is especially true for patients with bacteremia due to enteric organisms.
Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213-2583, USA.
L
L
Sigurdsson
J
J
Reyes
S A
SA
Kocoshis
G
G
Mazariegos
K
K
Abu-Elmagd
M
M
Green
D000293:Adolescent; D001228:Aspergillosis / Q000150:complications / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D016470:Bacteremia / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D006084:Graft Rejection / Q000150:complications / Q000382:microbiology; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications; D007422:Intestines / Q000382:microbiology / Q000637:transplantation*; D008232:Lymphoproliferative Disorders / Q000150:complications; D013997:Time Factors; D014181:Transplantation Immunology