Background: Although infections post renal transplantation are a main cause of morbidity and mortality, data focusing on children are scarce. The objective of this study was to investigate the incidence, etiology and predictors of infection in pediatric renal-transplant recipients in a specific setting of hospitalization due to fever, in order to elucidate the appropriate approach for these patients.
Methods: Clinical and laboratory data were retrospectively collected for all febrile hospitalized pediatric renal-transplant recipients in a national center for renal-transplantation, during a 9-year period, from 2004 to 2012.
Results: One hundred and sixty eight hospital admissions due to fever amongst 52 transplanted children were analyzed. Of these, 85 bacterial (50.6%), 67 viral (39.9%), 3 parasitic and 2 fungal infections were diagnosed. Bacterial infections were most frequent during the first year after transplantation with urinary tract infection being the most prevalent infection. Seven cases of bacteremia were observed, including one presenting with severe sepsis. Of the 48 microbiology-confirmed bacterial infections, gram-negative bacteria, namely Enterobacteriaceae, were most common (61.2%). Compared with a white blood cell count and absolute neutrophil count, C-reactive protein was found more sensitive in predicting bacterial disease. Additional risk factors for bacterial infection included older age, presence of a central venous catheter and sonographic findings compatible with infection.
Conclusion: Febrile hospitalized renal-transplant patients are immunocompromised hosts at a high risk for bacterial infections and usually warrant empirical antibiotic treatment upon admission. In the minority of cases of low-risk patients, one can consider to withhold antibiotic treatment with close follow-up.
