The following is a summary of “Frequency of Bacteremia and Urinary Tract Infection in Pediatric Renal Transplant Recipients” published in the December 2022 issue of Pediatric Infectious Disease by Cruz et al.

Their major objective was to discover clinical and biochemical characteristics related to bacteremia in pediatric renal transplant patients presenting with suspected infection within 2 years of transplant and evaluate the prevalence of bacteremia and urinary tract infections (UTI). Researchers used a retrospective cross-sectional design to analyze all cases of suspected infection within 2 years of the transplant date among pediatric (18 years old) renal transplant recipients seen at 3 large children’s hospitals between 2011 and 2018. Suspected infection was defined as a temperature of(>38°C) or higher or the ordering of blood culture. Primary immunodeficiency patients, patients with non-transplant immunosuppression, patients with intestinal failure, and patients who had relocated beyond the area were not allowed to participate.

Pneumonia, bacterial or fungal meningitis, respiratory virus infections, and antibiotic resistance were considered subsequent outcomes of bacteremia or UTI. Every trip was broken down into its component parts. The findings show that within 2 years of receiving a transplant, 115 children went through 267 evaluations for infections. As for urinary tract infections, 63 out of 189 (33.3% of the total) patients were diagnosed with one, and bacteremia was found in 9 (2.8%). Tachycardia was present in 66.7% of visits with confirmed bacteremia, whereas in 0% of visits, hypotension was observed. There was no difference between bacteremic and nonbacteremic individuals in terms of white blood cell count (12,700 cells/mm3 vs. 10,900 cells/mm3; P=0.43) or absolute neutrophil count (10,700 vs. 8200 cells/mm3; P=0.24). 

Children with bacteremia had a higher absolute band count (1900 vs. 600 cells/mm3; P=0.02). Gram-negative bacteria showed resistance to semisynthetic penicillins (12.7%), third-generation cephalosporins (14.5%), and carbapenems (3.6%).  About 1/4 of all children who received a kidney transplant and subsequently presented with suspected infection were found to have bacteremia or UTIs within 2 years of the donation. Results could have been more consistent with no urine cultures taken in 1/3 of visits. Patients with bacteremia could not be accurately recognized by a single demographic, clinical, or laboratory feature; however, a combination of observations may help to identify a high-risk population.