Epidemiology of bloodstream infections in the first year after pediatric lung transplantation.
BACKGROUND
Substantial morbidity and mortality rates are associated with infections in the first year after pediatric lung transplantation. To understand better the clinical significance of bloodstream infections (BSIs), we evaluated systematically the epidemiologic features of BSIs in the first year after transplantation.


METHODS
A retrospective case-cohort study of pediatric primary lung transplant recipients was performed. The frequency of BSIs and the organisms isolated were determined through medical and laboratory record review. We assessed variations in causative organisms and rates of BSIs in 3 time periods after transplantation, ie, early (0-30 days), intermediate (31-90 days) and late (91-365 days).


RESULTS
Between July 1990 and November 2000, 190 pediatric patients received primary lung transplants. Twenty-six percent (49 of 190) of recipients had at least 1 BSI. The most commonly isolated organisms were coagulase-negative Staphylococcus (n = 25, 28.4%), Pseudomonas aeruginosa (n = 14, 16.0%) and Candida spp. (n = 9, 10.2%). The overall rate of BSIs was 2.1 episodes per 1000 catheter-days. The highest rate of BSIs occurred in the early period, compared with the intermediate and late periods (5.5, 1.3 and 1.6 episodes per 1000 catheter-days, respectively; P = 0.21). Early BSIs were associated with death in the first year after transplantation (relative risk, 3.9; 95% confidence interval, 1.6-9.4; P = 0.002).


CONCLUSIONS
BSIs occur frequently after primary pediatric lung transplantation, with the highest rate being in the first 30 days after transplantation. Early BSIs are associated with death in the first year after transplantation.
Danziger-Isakov
Lara A
LA
Department of Medical Subspecialty Pediatrics/A120, The Cleveland Clinic Foundation, The Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA. danzigl@ccf.org
Sweet
Stuart
S
Delamorena
Maite
M
Huddleston
Charles B
CB
Mendeloff
Eric
E
Debaun
Michael R
MR
D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D001769:Blood / Q000382:microbiology; D002175:Candida / Q000145:classification / Q000302:isolation & purification; D002177:Candidiasis / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003470:Culture Media; D005260:Female; D016469:Fungemia / Q000453:epidemiology* / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male
D003470:Culture Media