Etiology and management of cholangitis in pediatric liver transplant recipients: a systematic review.

PURPOSE OF REVIEW: Children undergoing liver transplantation are highly vulnerable to infections. Cholangitis is a potential post-transplant complication requiring broad-spectrum anti-infective therapy, raising concerns about antimicrobial resistance in this immunosuppressed population. We conducted a systematic review to evaluate antimicrobial management of post-transplant cholangitis in pediatric patients.

RECENT FINDINGS: Nine heterogeneous studies were included. Definitions of cholangitis varied widely, combining clinical, laboratory, imaging, and microbiological criteria, highlighting the need for standardization. Gram-negative bacteria predominated, particularly Klebsiella spp., Pseudomonas aeruginosa , and Escherichia coli . Prophylaxis commonly relied on broad-spectrum antibiotics, and initial treatment was empirical in all studies, with occasional adjustment based on microbiological results. First-line therapies included piperacillin-tazobactam and third-generation cephalosporins. Second-line regimens involved agents from various antibiotic classes, including glycopeptides, lipopeptides, aminoglycosides, and fluoroquinolones, as well as antifungals. Meropenem was used as either first-line or second-line therapy.

SUMMARY: Improved characterization and standardized reporting of pathogens and treatments are needed to guide targeted antimicrobial strategies and limit multidrug-resistant organisms. More detailed and harmonized data reporting is essential to optimize management of post-transplant cholangitis in children.