One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: A randomized, controlled clinical trial

Orlando, Giuseppe; Manzia, Tommaso Maria; Sorge, Roberto; Iaria, Giuseppe; Angelico, Roberta; Sforza, D.; Toti, Luca; Peloso, Andréa; Patel, Timil; Katari, Ravi; Zambon, João Paulo; Maida, Andrea; Salerno, Maria Paola; Clemente, K.; Cocco, Pierpaolo Di; Luca, Linda De; Tariciotti, Laura; Famulari, A.; Citterio, Franco; Tisone, Giuseppe; Pisani, F.; Romagnoli, Jacopo

doi:10.1016/j.surg.2014.06.007

Cited by 41 publications

(26 citation statements)

References 15 publications

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“…The duration of AMP varies from no need, to a single dose, to administration for 1-3 days. [29][30][31][32] Previously, we carried out surveillance of 13 institutions with 20 or more renal transplantation cases per year in Japan, and found that firstgeneration cephalosporins were most frequently used as AMP (unpubl. data).…”

Section: Preoperative Managementmentioning

confidence: 99%

Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition

Yamamoto

Shigemura

Kiyota³

et al. 2016

Int J of Urology

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After publication of the initial version of the Japanese guidelines for urological surgery in 2007, new surgical techniques have been introduced. Furthermore, several important issues, such as criteria for use of single-dose antimicrobial prophylaxis and control of hospitalized infection, were also established, which led to alterations of the methods used for antimicrobial prophylaxis as well as perioperative management. The purpose of antimicrobial prophylaxis is to protect the surgical wound from contamination by normal bacterial flora. Antimicrobial prophylaxis should be based on penicillins with beta-lactamase inhibitors, or first-or second-generation cephalosporins, though penicillins without beta-lactamase inhibitors should not be prescribed because of the high prevalence of antimicrobial resistance. As an adequate intratissue concentration of the antimicrobial at the surgical site should be accomplished by the time of initiation of surgery, antimicrobial prophylaxis should be started up to 30 min before beginning the operation. Antimicrobial prophylaxis should be terminated within 24 h in clean and clean-contaminated surgery, and within 2 days of surgery using the bowels, because a longer duration is a risk factor for surgical site infection development. Importantly, possible risk factors for surgical site infections include the antimicrobial prophylaxis methodology used as well as others, such as duration of preoperative hospitalization, hand washing, the American Society of Anesthesiologists score, diabetes and smoking history. These guidelines are to be applied only for preoperatively non-infected low-risk patients. In cases with preoperative infection or bacteriuria that can cause a surgical site infection or urinary tract infection after surgery, patients must receive adequate preoperative treatment based on the individual situation.

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Section: Preoperative Managementmentioning

confidence: 99%

Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition

Yamamoto

Shigemura

Kiyota³

et al. 2016

Int J of Urology

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“…A single shot perioperative antibiotic prophylaxis appears to be su cient. [19] Interestingly, Bachmann et al described 16 different perioperative antibiotic prophylaxis schemes in 65 Eurotransplant KT centers. [4] With regards to the randomized trial and the non-inferiority of a single shot PAP we changed our protocol to a single shot cephalosporin before incision.…”

Section: Discussionmentioning

confidence: 99%

“…[4] Since 2018 the EAU Guidelines [20] recommend a single shot antibiotic prophylaxis based on one multicentric randomized trial. [19] UTIs are de ned as the growth of 10^5 colony building units on a proper urine sample (i.e. morning urine, puncture urine or from sterile single catheterization).…”

Section: Introductionmentioning

confidence: 99%

Guidance of antibiotic treatment for urinary tract infections in the early postoperative phase after Kidney Transplantation

Strohäker

Nadalin

Königsrainer

et al. 2020

Preprint

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Purpose: Urinary tract infections are the most common infections early after kidney transplantation. The goals of this study were to evaluate our perioperative antibiotic protocol and risk factors for the occurrence of urinary tract and its effect on the early graft function. We evaluated laboratory alterations during episodes of UTI regarding their potential to guide treatment.Methods: Retrospective single-center analysis of all kidney transplant recipients of an academic transplant center between 2015 and 2017.Results: 96 patients were included in the study. Overall, in 22 patients a asymptomatic bacteriuria (ASB) was detected and 33 patients developed a urinary tract infection (UTI). Gram-negative UTIs appeared earlier than gram-positive UTIs. The most common lab findings during UTI were leukocytosis and CRP increase, both more common in gram-negative UTI (p .00 & .03). All complicated UTIs were caused by gram-negative bacteria (p .00). No difference in UTIs was seen between perioperative antibiotic regimens. Patients that suffered from UTIs showed less favorable graft function at discharge (GFR 43 vs 52 ml / min, p .03).Conclusion: UTIs are associated with worse graft functions while ASBs are not. Whether UTIs are caused by or lead to decreased graft function is still unclear. Proper gram-negative coverage is needed in cases of complicated UTIs or severe laboratory findings. Perioperative antibiotic regimens appear to have no beneficial influence on the incidence of UTIs.

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“…Despite some controversy for the use of surgical antibiotic prophylaxis, routine prescribing is common, generally following local practices and guidelines [22]. No consensus currently exists for optimal antibacterial prophylaxis, but the general approach is to minimise dose and duration of administration to prevent emergence of antibiotic resistance [23]. A Cochrane systematic review is currently being undertaken to evaluate the evidence for antibiotic prophylaxis in preventing postsurgical site infections in solid organ transplant recipients [24].…”

Section: Prophylactic Medicationsmentioning

confidence: 99%

Perioperative Care for Kidney Transplant Recipients

Hultin¹,

Hawley²,

Johnson³

et al. 2019

Perioperative Care for Organ Transplant Recipient

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Transplantation carries significant mortality benefit compared to dialysis in end-stage kidney disease. Increased perioperative risk, however, results in a higher mortality in the first 3 months post-transplantation compared to remaining on haemodialysis. Consequently, optimal perioperative management is essential. Patients presenting for kidney transplantation require rapid assessment and preparation for theatre to minimise ischaemic times and improve mortality and graft outcomes. This task is often complicated by the presence of multiple medical comorbidities. Furthermore, early complications of hypotension, delayed graft function, renovascular and ureteric surgical complications and rejection render the perioperative phase of transplant challenging for the recipient and for the transplant team. In this chapter, we outline current practices in the assessment and management of kidney transplant recipients during the perioperative period, particularly focusing on their clinical application and the evidence underpinning them.

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One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: A randomized, controlled clinical trial

Cited by 41 publications

References 15 publications

Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition

Essential Japanese guidelines for the prevention of perioperative infections in the urological field: 2015 edition

Guidance of antibiotic treatment for urinary tract infections in the early postoperative phase after Kidney Transplantation

Perioperative Care for Kidney Transplant Recipients

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