title: Surveillance for infectious complications in pediatric acute liver failure - a prospective study.
abstract: OBJECTIVE
  To prospectively evaluate infectious complications (IC) in pediatric acute liver failure (PALF) by employing surveillance cultures.
  
  
  METHODS
  From 2011 to 2013, children with PALF in a tertiary care centre received a standard protocolised management. Prophylactic parenteral antibiotics were used without antifungals. Surveillance cultures of blood, urine, ascites and tracheal aspirates were sent. Biochemical and clinical parameters and outcomes were compared between children with and without IC.
  
  
  RESULTS
  Of the 29 children with PALF admitted during the study period (median age 36 mo, range 12-90 mo), 13.8 % had blood stream infections (BSI) at admission. Organisms were isolated in 8.8 % (12/136) of the blood cultures, 13.7 % (11/80) of the urine cultures, 30.8 % (8/26) of the tracheal aspirates and 7.1 % (1/14) of the ascitic fluid cultures. Gram negative bacteriae (n = 17) were the commonest, followed by fungi (n = 13) and gram positive bacteriae (n = 2). Klebsiella pneumoniae and Candida nonalbicans group were the commonest bacteria and fungi respectively. After admission, fungal BSI and urinary tract infections were diagnosed at a median time of 4 d (range 3-8 d) and 3.5 d (range 3-6 d) respectively. ICs were not associated with other complications and increased mortality but with longer hospital and pediatric intensive care unit (PICU) stay.
  
  
  CONCLUSIONS
  In this study BSI was a common finding at admission in PALF. Inspite of prophylactic antibiotics, break through gram negative bacterial and fungal ICs were common. Empirical treatment of IC should include broad spectrum antibiotics. Fungal IC occurred beyond 48 h. Prophylactic antifungals at admission may be considered to decrease their frequency. IC prolongs PICU and hospital stay.
authors.affiliation: Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry, 605006, India.
authors.forename: Suresh
authors.initials: S
authors.lastname: Mekala
authors.forename: Barath
authors.initials: B
authors.lastname: Jagadisan
authors.forename: Subhash Chandra
authors.initials: SC
authors.lastname: Parija
authors.forename: Subitha
authors.initials: S
authors.lastname: Lakshminarayanan
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods / Q000706:statistics & numerical data; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D001431:Bacteriological Techniques / Q000379:methods / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D017114:Liver Failure, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D009181:Mycoses / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000652:urine; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents