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Invasive pneumococcal infections in pediatric liver‐small bowel‐pancreas transplant recipients
Author(s) -
Vo Hanh D.,
Florescu Diana F.,
Brown Cindy R.,
Chambers Heather E.,
Mercer David F.,
Vargas Luciano M.,
Grant Wendy J.,
Langnas Alan N.,
QuirosTejeira Ruben E.
Publication year - 2018
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/petr.13165
Subject(s) - medicine , bacteremia , pneumonia , sepsis , meningitis , streptococcus pneumoniae , splenectomy , pediatrics , antibiotics , spleen , microbiology and biotechnology , biology
Children undergoing LSBPT x are at increased risk of IPI due to splenectomy. We aimed to describe the clinical features and outcomes of IPI in pediatric LSBPT x recipients. Between 2008 and 2016, 122 LSBPT x children at our center were retrospectively reviewed. Nine patients had 12 episodes of IPI ; the median age at first infection was 3.5 years (range: 1.5‐7.1 years). The median time from transplant to first infection was 3 years (range: 0.8‐5.8 years). Clinical presentation included as follows: pneumonia (n = 1), bacteremia/sepsis (n = 7), pneumonia with sepsis (n = 1), meningitis with sepsis (n = 2), pneumonia and meningitis with sepsis (n = 1). The overall risk for IPI was 7.4% or 0.9% per year. The mortality rate was 22%. Seven (78%) children had received at least one dose of PCV 13, four (44%) patients had received 23‐valent pneumococcal polysaccharide vaccine prior to IPI . All patients were on oral penicillin prophylaxis. In conclusion, despite partial or complete pneumococcal immunization and reported antimicrobial prophylaxis, IPI in LSBPT x children can have a fatal outcome. Routine monitoring of pneumococcal serotype antibodies to determine the timing for revaccination might be warranted to ensure protective immunity in these transplant recipients.