Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation: A Survey Among Member Centers of the European Reference Network <scp>TransplantChild</scp>

BACKGROUND: Antimicrobial management in pediatric transplantation lacks standardized international guidelines, and current practices across European transplant centers remain poorly described. This study aimed to evaluate microbiological screening and peri-transplant antimicrobial strategies among centers participating in the European Reference Network on Transplantation in Children (ERN TransplantChild), including both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) programs. METHODS: Between December 2022 and February 2023, healthcare professionals within the network completed a structured survey addressing microbiological screening practices and peri-transplant antimicrobial strategies in pediatric transplant recipients. RESULTS: Of 127 transplant programs invited, 76 (59.8%) responded, including 62 SOT and 14 HSCT programs from 36 centers across 16 European countries. Pre-transplant screening strategies, microbiological methods, and decolonization practices varied substantially between centers. Reported prevalence of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing organisms was below 10% in most programs. In SOT, perioperative prophylaxis varied according to transplanted organ type. Cephalosporins were most commonly used in kidney and heart transplantation, whereas broader-spectrum regimens, including piperacillin-tazobactam and vancomycin, were more frequently adopted in liver, intestinal, and lung transplantation. Postoperative prophylaxis was continued beyond 24 h in most SOT programs. Antifungal prophylaxis was more commonly adopted in liver, intestinal, and lung transplant recipients. In HSCT, antibacterial peri-transplant use was not routinely prescribed in a substantial proportion of programs, particularly in autologous transplantation, whereas antifungals were widely used in allogeneic HSCT. CONCLUSIONS: Marked heterogeneity in microbiological screening and peri-transplant antimicrobial strategies across European pediatric transplant centers underscores the need for transplant-specific, evidence-based guidelines distinguishing between SOT and HSCT settings. These findings provide a foundation for the development of shared clinical pathways and harmonized recommendations.

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Journal
Pediatric Transplantation
Published
2026-06-26
DOI
https://doi.org/10.1111/petr.70379
Primary Topic
Neutropenia and Cancer Infections
Type
article
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article

Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation: A Survey Among Member Centers of the European Reference Network TransplantChild

Licia Peruzzi, Håkan Wåhlander, Michele Pinon, Zivile Békássy et al.
Pediatric Transplantation
Neutropenia and Cancer Infections
article

Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation: A Survey Among Member Centers of the European Reference Network TransplantChild

Licia Peruzzi, Håkan Wåhlander, Michele Pinon, Zivile Békássy, Dominik Turkiewicz, Andrea Pietrobattista, Maria Loreto Hierro, U Cucinotta, Daniele Donà, Michal Odermarsky, Sandra Ferreira, Júlia Marsal, Silvia Catalano, Cecilia Liberati, Esther Ramos Boluda, B Fischler, Jelena Rascon, Karin Mellgren, Olga de la Serna Blázquez, Ryszard Grenda, Alejandro Zarauza, S J Sørensen, Susanne Westphal, Inga Vainumäe, Uta Herden, Piotr Kaliciński, Antonio Marzollo, Francesco Saglio, Anita Verma, Luz Yadira Bravo‐Gallego, Elisa Benetti, Ana Rita Sandes, Clodagh Sweeney, Marco Sciveres, F Hernández, Xavier Stéphenne, Huib de Jong, Giusy Ranucci, Martin Tepel, Lars Wennberg, Karsten Kötz, Brigitte W.M. Willemse, Victoria Bordon, Valeria Casotti, Nuria Gil, Agnieszka Prytula-Ebels, Marta González Vincent, Enrico Aidala, Francisco de la Cerda-Ojeda, A. Madrid, Luís García Guereta, Daniela Grima, Anna Bjerre, Khalid Sharif, David Bueno Sánchez, Adriana Warrington, Patrícia Costa-Reis, Maria Mercadal-Hally, Timo Jahnukainen, Ana Texeira, Frauke Mutschler, Nicolaus Schwerk, the ERN‐TransplantChild, Maria Francelina Lopes, Tom Wolfs, Mercedes Lopez Gonzales, Dominique Debray, José María Pérez‐Hurtado De Mendoza, Natalia Mendoza‐Palomar, Jorge Huerta, Augustina Jankauskiene, Ferran Gran‐Ipiña, Antonia H. M. Bouts
article en

Abstract

BACKGROUND: Antimicrobial management in pediatric transplantation lacks standardized international guidelines, and current practices across European transplant centers remain poorly described. This study aimed to evaluate microbiological screening and peri-transplant antimicrobial strategies among centers participating in the European Reference Network on Transplantation in Children (ERN TransplantChild), including both solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT) programs. METHODS: Between December 2022 and February 2023, healthcare professionals within the network completed a structured survey addressing microbiological screening practices and peri-transplant antimicrobial strategies in pediatric transplant recipients. RESULTS: Of 127 transplant programs invited, 76 (59.8%) responded, including 62 SOT and 14 HSCT programs from 36 centers across 16 European countries. Pre-transplant screening strategies, microbiological methods, and decolonization practices varied substantially between centers. Reported prevalence of methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing organisms was below 10% in most programs. In SOT, perioperative prophylaxis varied according to transplanted organ type. Cephalosporins were most commonly used in kidney and heart transplantation, whereas broader-spectrum regimens, including piperacillin-tazobactam and vancomycin, were more frequently adopted in liver, intestinal, and lung transplantation. Postoperative prophylaxis was continued beyond 24 h in most SOT programs. Antifungal prophylaxis was more commonly adopted in liver, intestinal, and lung transplant recipients. In HSCT, antibacterial peri-transplant use was not routinely prescribed in a substantial proportion of programs, particularly in autologous transplantation, whereas antifungals were widely used in allogeneic HSCT. CONCLUSIONS: Marked heterogeneity in microbiological screening and peri-transplant antimicrobial strategies across European pediatric transplant centers underscores the need for transplant-specific, evidence-based guidelines distinguishing between SOT and HSCT settings. These findings provide a foundation for the development of shared clinical pathways and harmonized recommendations.

Pediatric TransplantationVol. 30(7)
Hebron University (PS), Universitat Autònoma de Barcelona (ES), Oslo University Hospital (NO), Hôpital Necker-Enfants Malades (FR), Hospital Sant Joan de Déu Barcelona (ES), Cliniques Universitaires Saint-Luc (BE), University Medical Center Groningen (NL), Karolinska University Hospital (SE), University of Padua (IT), Universität Hamburg (DE), Vilnius University (LT), Hospital Universitario La Paz (ES), Sahlgrenska University Hospital (SE), Mater Dei Hospital (MT), Ghent University Hospital (BE), Odense University Hospital (DK), Hospitais da Universidade de Coimbra (PT), Tartu University Hospital (EE), Copenhagen University Hospital (DK), Rigshospitalet (DK), Karolinska Institutet (SE), Hospital General Universitario Gregorio Marañón (ES), Children's Health Ireland at Crumlin (IE), Medizinische Hochschule Hannover (DE), Institut Necker Enfants Malades (FR), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Helsinki Children's Hospital (FI), Hospital La Luz (ES), Emma Kinderziekenhuis (NL), Birmingham Women's Hospital (GB), Birmingham Children's Hospital (GB), Vall d'Hebron Institut de Recerca (ES), Hospital La Paz Institute for Health Research (ES), Ospedale Papa Giovanni XXIII (IT), University Medical Center Hamburg-Eppendorf (DE), Administração Regional de Saúde de Lisboa e Vale do Tejo (PT), Centre for Biomedical Network Research on Rare Diseases (ES), Hospital Infantil Universitario Niño Jesús (ES), Children's Memorial Health Institute (PL), Bambino Gesù Children's Hospital (IT), Hospital de Santo António (PT), Vall d'Hebron Hospital Universitari (ES), Hospital Materno-Infantil (ES), Ospedale Regina Margherita (IT), Skåne University Hospital (SE), Erasmus MC - Sophia Children’s Hospital (NL), Hospital de Santa Maria (PT), Hospital Universitario Virgen del Rocío (ES), King's College Hospital (GB), Vilnius University Hospital Santariskiu Klinikos (LT), Wilhelmina Children's Hospital (NL), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Coimbra (PT), University of Amsterdam (NL)
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Neutropenia and Cancer Infections
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