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.
}}, author = {{Donà, Daniele and Liberati, Cecilia and Aidala, Enrico and Bekassy, Zivile and Bjerre, Anna and Bordon, Victoria and Sanchez, David Bueno and Bouts, Antonia H M and Bravo-Gallego, Luz Yadira and Casotti, Valeria and Catalano, Silvia and Costa-Reis, Patricia and Cucinotta, Ugo and Debray, Dominique and De Jong, Huib and De la Cerda-Ojeda, Francisco and De la Serna, Olga and Ferreira, Sandra and Fischler, Björn and Guereta, Luis García and Gil, Nuria and Vincent, Marta González and Gran-Ipiña, Ferran and Grenda, Ryszard and Grima, Daniela and Herden, Uta and Hierro, Maria Loreto and Huerta, Jorge and Jahnukainen, Timo and Jankauskiene, Augustina and Kaliciński, Piotr and Kötz, Karsten and Lopes, Maria Francelina and Gonzales, Mercedes Lopez and Madrid, Álvaro and Mercadal-Hally, Maria and Marsal, Julia and Marzollo, Antonio and Mellgren, Karin and Mendoza-Palomar, Natalia and Mutschler, Frauke and Odermarsky, Michal and De Mendoza, José María Pérez-Hurtado and Peruzzi, Licia and Pietrobattista, Andra and Pinon, Michele and Prytula, Agnieszka and Ramos, Esther Boluda and Ranucci, Giusy and Turkiewicz, Dominik}}, issn = {{1399-3046}}, keywords = {{Humans; Hematopoietic Stem Cell Transplantation; Europe; Organ Transplantation; Child; Antibiotic Prophylaxis/methods; Practice Patterns, Physicians'/statistics & numerical data; Surveys and Questionnaires; Anti-Bacterial Agents/therapeutic use}}, language = {{eng}}, number = {{7}}, publisher = {{Wiley-Blackwell}}, series = {{Pediatric Transplantation}}, title = {{Antimicrobial Prophylaxis in Solid Organ and Hematopoietic Stem Cell Transplantation : A Survey Among Member Centers of the European Reference Network TransplantChild}}, url = {{http://dx.doi.org/10.1111/petr.70379}}, doi = {{10.1111/petr.70379}}, volume = {{30}}, year = {{2026}}, }