Bacteraemia, UTI not uncommon in paediatric renal transplant recipients

A few paediatric renal transplant recipients who presented with suspected infection within 2 years of transplant were diagnosed with bacteraemia or urinary tract infections (UTIs) or both, reports a study. Evaluations are highly variable, with a third of visits without urine cultures obtained.

This retrospective, cross-sectional study included all paediatric (<18 years old) renal transplant recipients seen at three large children’s hospitals from 2011 to 2018 for suspected infection within 2 years of transplant date, defined as pyrexia (>38 °C) or a blood culture being ordered.

Those with primary immunodeficiencies, nontransplant immunosuppression, intestinal failure, and who had moved out of the local area were excluded. Bacteraemia or UTI was the primary outcome, while secondary ones included pneumonia, bacterial or fungal meningitis, respiratory viral infections, and antibiotic resistance. The unit of analyses was the visit.

A total of 267 visits for infection evaluation within 2 years of transplant from 115 children were evaluated. Bacteraemia (with or without UTI) was diagnosed in nine of 213 (4.2 percent) visits and UTIs in 63 of 189 (33.3 percent). Moreover, tachycardia and hypotension were detected in 66.7 percent and 0 percent of visits with documented bacteraemia, respectively.

White blood cell (12,700 cells/mm³ vs. 10,900 cells/mm³; p=0.43) and absolute neutrophil count (10,700 vs 8,200 cells/mm³; p=0.24) were comparable between bacteraemic and nonbacteraemic patients. The absolute band count was higher in those with bacteraemia (1,900 vs 600 cells/mm³; p=0.02).

Among Gram-negative pathogens, antibiotic resistance was observed with third- (14.5 percent) and fourth-generation cephalosporins (3.6 percent), 12.7 percent with semisynthetic penicillins, and 3.6 percent with carbapenems.

“No single demographic, clinical, or laboratory variable accurately identified patients with bacteraemia, although combinations of findings may identify a high-risk population,” the authors said.