Objective: To describe characteristics of liver transplant patients with severe sepsis in the pediatric intensive care unit (PICU) Design: Retrospective descriptive analysis Setting: Tertiary children's hospital PICU Patients: Liver transplant recipients admitted Jan 2010 to Jul 2016 for pediatric severe sepsis Interventions: None Measurements and Main Results: Between Jan 2010-Jul 2016, 173 liver transplants were performed, and 36 of these patients (21%) were admitted with severe sepsis (54 episodes total). Median age at admission was 2 y [1-6.5 y], 47.2% were male. Bacterial infections were the most common (77.8%), followed by culture negative (12.9%) and viral infections (7.4%). Fungal infections accounted for only 1.9%. Median time from transplant for viral and culture negative infections was 18 d [8.25-39.75 d] and 25 d [9-41 d], while 54.5 d [17-131.25 d] for bacterial infections. Bloodstream and intra-abdominal were the most common bacterial sites (45% and 22.5%, respectively). Multidrug-resistant organisms (MDROs) accounted for 47.6% of bacterial sepsis. Vancomycin resistant enterococcus and extended spectrum beta-lactamase producers were the most frequently identified MDROs. Patients with MDRO sepsis demonstrated higher admission PELOD scores (P=0.043) and were noted to have an odds ratio of 3.8 and 3.6 for mechanical ventilation and MODS, respectively (P=0.047 and P=0.044). Overall mortality was 5.5% (n=2 patients), with both deaths occurring in MDRO episodes.
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