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Experience with the use of piperacillin–tazobactam in pediatric non‐renal solid organ transplantation
Author(s) -
Wiesmayr Silke,
Stelzmueller Ingrid,
Mark Walter,
Muehlmann Gilbert,
Tabarelli Walther,
Tabarelli Dominique,
Laesser Rainer,
Antretter Herwig,
Ladurner Ruth,
Zimmerhackl LotharBernd,
Margreiter Raimund,
Guggenbichler JosefPeter,
Bonatti Hugo
Publication year - 2007
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2006.00605.x
Subject(s) - medicine , pneumonia , transplantation , tazobactam , piperacillin , urinary system , piperacillin/tazobactam , sepsis , anaerobic bacteria , surgery , kidney transplantation , gastroenterology , pseudomonas aeruginosa , bacteria , biology , genetics
Abstract: Bacterial infection remains a major problem after solid organ transplantation (SOT), especially in children. Piperacillin–tazobactam (Pip–Tazo) is a beta‐lactam‐antibiotic combination with a broad spectrum of activity including gram‐positive cocci as well as gram‐negative rods, non‐fermentative and anaerobic bacteria. The aim of this retrospective study was to critically review our experience with Pip–Tazo as perioperative prophylactic agent in pediatric non‐renal SOT. Between 1993 and 2003 Pip–Tazo was used as initial perioperative prophylaxis in 45 pediatric patients who underwent a total of 49 transplants (36 liver‐, seven cardiac‐, two lung‐, and four small bowel‐) at our department. Median age of the children was 7.9 (range 0.5–18.1) years. A total of 34 rejection episodes following 27 transplants were diagnosed. During first hospitalization 44 infectious episodes were observed. Bacteria were responsible for 22 episodes including sepsis (n = 10), pneumonia (n = 5), wound infection (n = 4), urinary tract infection (n = 1), and clostridial colitis (n = 2). The isolated organisms were gram‐positive cocci (n = 12), gram‐negative rods (n = 3), non‐fermentative bacilli (n = 4), and anaerobes (n = 3). Ten episodes were caused by Pip–Tazo resistant bacteria. Twenty‐one of these infections were observed following antirejection therapy with pulse steroids. At later time points nine infectious episodes were successfully treated with a second course of Pip–Tazo. During follow up, eight patients died. Six deceased perioperatively: five from infection including aspergillosis (n = 4) and Pneumocystis jiroveci pneumonia (n = 1) and cerebrovascular bleeding (n = 1) and two children later on. At present 37 children (82%) are alive with well functioning graft after a median follow up of 39.2 (range 0.6–123.5) months. No severe side effects caused by Pip–Tazo were observed in any of the children. Pip–Tazo may be a suitable single agent for perioperative prophylaxis in pediatric non‐renal solid organs recipients, however, a prospective comparative study is needed to make final conclusions.