P3.43: Bloodstream infections in children following intestinal transplantation

Background: Infection is the leading cause of death in small bowel and multivisceral organ transplantation. It has been reported that the incidence of blood stream infection (BSI) is higher in children compared to adults, reaching almost 80% in some centers. In the UK there is limited data describing the incidence, aetiology and outcome of BSI in children receiving small bowel and multivisceral organ transplant. Methods: Retrospective review of patients undergoing small bowel and multivisceral transplants at a tertiary centre from 1993 until 2015. Results: A total of 92 patients received isolated small bowel (n=30), liver-small bowel (n=49), liver, small bowel and pancreas (n=8), multivisceral (n=1) and modified multivisceral (n=4) transplants. Mean age at transplant was 4.3 years (range 7 months to 16 years). Bacteremia was observed in 58% (53/92) of patients (total of 103 episodes); eight patients had ≥3 episodes of BSI. Gram positive organisms were the most frequently isolated (73/103 episodes), with coagulase negative Staphylococci accounting for 63% of these cultures. Gram negatives and Candida were identified in 12% (12/103) and 5% (5/103) of episodes respectively. All Gram negative BSI occurred ≥150 days post-transplant, while 60% of infection caused by Staphylococcus aureus and Enterococcus was observed <150 days post-transplant. Overall survival was higher in those without culture confirmed bacteremia (54% vs.40%). Thirty day mortality post bacteremia was 6.8% in this cohort. Discussion: In this retrospective case series 58% of patients suffered from at least one episode of bacteraemia, an incidence lower than that previously reported. Timing of BSI differed by aetiology, with Gram negative infections observed later than Gram positive infections. Overall survival was lower in those with BSI, compared to those without BSI. Conclusion: Blood stream infections are common following intestinal transplantation and vigilance and prompt treatment may prevent mortality in children following intestinal transplantation