Risk factors for early invasive fungal infections in paediatric liver transplant recipients

Abstract

Invasive fungal infections (IFIs) postliver transplantation are a frequent cause of morbidity and mortality; however, studies reporting on these infections in the paediatric population are scarce. To investigate the incidence and risk factors of IFIs in paediatric liver transplant recipients during the early posttransplantation period (≤3 months). Data were collected for all paediatric liver transplant recipients registered in a national transplantation center from 2004 to 2014. Using a stepwise logistic regression to identify independent risk factors for IFIs, a predictive model was formulated. Ten IFIs were identified in 81 liver transplant recipients (12.3%) all occurring during the first month posttransplantation. Candida species were responsible for nine cases (90%), of which four were non-albicans Candida (44%). Significant risk factors were identified; recipient of multiple blood product transfusions during transplantation, prolonged use of indwelling intravenous catheter, prolonged IV antibiotic treatment, surgical complications, pulse steroid treatment and living donor liver transplantation. The predictive model used two clinical parameters to define high-risk patients: a living donor transplantation and duration of IV antibiotic treatment (area under the ROC curve 0.918). IFIs are a significant complication occurring in the first month posttransplantation. Future studies are required to assess efficacy of targeted antifungal prophylaxis in high risk patients.

Navigating the New Reality: A Review of the Epidemiological, Clinical, and Microbiological Characteristics of Candida auris, with a Focus on Children

“…The colonization sites, clinical spectrum of disease, characteristics of affected patients and the risk factors for invasive disease were similar between infections caused by C. auris and by other Candida species [ 40 , 47 , 98 ]. However, prior colonization as a risk factor for developing candidemia was not clearly described for C. auris , as described for other Candida species [ 40 ].…”

Fungal Infections in Gastroenterology

“…IFIs in pediatric liver transplant recipients during the early post transplantation period (<3 months) - [46]. Data were collected for all pediatric liver transplant recipients recipients registered in a national transplantation center from 2004-2014.…”

“…Significant risk factors were multiple blood products transfusion during transplantation, prolonged use of indwelling catheters, prolonged IV antibiotic treatment, surgical complications, pulse steroid treatment and living donor transplantation. The predictive model used two clinical parameters to define high -risk patients: a living donor transplantation and duration of IV antibiotic treatment (area under the ROC curve 0,98).The authors concluded that IFIs are a significant complication occurring in the first month post transplantation and future studies targeting antifungal prophylaxis in these high -risk patients are needed [46]. To date, only small studies and case-series analyzing clinical presentation and risk of IFIs in liver transplantation (LTRs) are available.…”

Factors predicting efficacy of ethanol lock therapy as catheter salvage strategy for pediatric catheter‐related infections

“…Long‐term central venous catheters (CVCs) are an important component of care of children with chronic diseases requiring prolonged vascular access for medication or parenteral nutrition. The use of long‐term CVCs is associated with serious complications, including central‐line associated bloodstream infections (CLABSI) 1,2 . CLABSI are usually difficult to cure; failure rates of 25‐50% have been reported 3–7 .…”