Single-center Experience with Perioperative Antibiotic Prophylaxis and Surgical Site Infections in Kidney Transplant Recipients

Abstract

Background: Infections in kidney transplant recipients are particularly challenging owing to the immunosuppressive treatment, usually long history of chronic illness, comorbidities and prior exposures to antibiotics. Among the most common complications early after surgery are surgical site infections. The aim of this study was to identify risk factors and evaluate epidemiological data regarding surgical site infections. Moreover, we were able to compare the current results with historical data from our institution when different perioperative antibiotic prophylaxis was practiced.Methods: We conducted a retrospective case-control study in a group of 254 deceased donor renal graft recipients transplanted in a single Central European institution. We evaluated epidemiological findings and resistance patterns of pathogens causing surgical site infections. We used multivariable logistic regression to determine risk factors for surgical site infections.Results: We revealed no differences in baseline characteristics between patients with and without surgical site infections. Ten surgical site infections (3.9%) were diagnosed (six superficial incisional, two deep incisional, and two organ/space). Eight species (19 strains) were identified, most of which were multi-drug resistant (63%). The most common was extended-spectrum β-lactamase producing Klebsiella pneumoniae (26%). We showed that statistically significant differences were present between reoperated and non-reoperated patients (adjusted odds ratio: 6.963, 95% confidence interval: 1.523-31.842, P = .012).Conclusions: Reoperation is an individual risk factor for surgical site infection after kidney transplantation. According to our experience, cefazolin-based prophylaxis can be safe and is associated with relatively low prevalence of surgical site infections.

Perioperative antibiotic stewardship in the organ transplant setting

“…First generation cephalosporin, namely cefazolin, has shown noninferiority to vancomycin and ceftriaxone in a randomized controlled trial (RCT), 25 to ceftriaxone and to piperacillin/flucloxacillin in more recent retrospective studies. 26,27 Duration of the PP should be limited to 24-48 h. 1). Only one RCT found no difference between vancomycin plus gentamicin versus cefazolin plus gentamicin in preventing postoperative infections, 25 and the role of antifungal prophylaxis is debated 28 depending on the study design and the surgery technique.…”

“…Staphylococcus aureus , coagulase‐negative Staphylococci (CoNS) and Enterococcus species are the most common organisms involved. First generation cephalosporin, namely cefazolin, has shown noninferiority to vancomycin and ceftriaxone in a randomized controlled trial (RCT), 25 to ceftriaxone and to piperacillin/flucloxacillin in more recent retrospective studies 26,27 . Duration of the PP should be limited to 24–48 h.…”