J Korean Soc Transplant.  2010 Mar;24(1):13-18. 10.4285/jkstn.2010.24.1.13.

Routine Perioperative Antibiotic Prophylaxis in Renal Transplantation: It Makes No Difference for Bacterial Infections

• Choi SU
• Oh CK
• Kim JH
• Shin GT
• Kim H
• Kim SJ
• Kim SI

• KMID: 2202218
• DOI: http://doi.org/10.4285/jkstn.2010.24.1.13

Abstract

BACKGROUND
Although it has been a popular practice to use preventative antibiotics for the kidney recipients, it could increase the cost, encourage the growth of resistant micro-organism and have adverse effects. There has been no reported concrete evidence about the benefits and risks of using peri-operative prophylactic antibiotics for an immunosuppressed population. Therefore, we retrospectively evaluated the differences in the incidences of bacterial infection and adverse events after transplant surgery according to using peri-operative prophylactic antibiotics.
METHODS
We reviewed retrospectively 106 cases of renal transplantations (cadaver donor: 42 cases, living donor: 64 cases) that were performed at Ajou University Hospital, Korea from January, 2006 to December, 2008. We divided the cases into two groups: Group A (n=41; 38.7%) included the patients who did not receive prophylactic antibiotics and Group B (n= 65; 61.3%) included the patients who did receive prophylactic antibiotics. We analyzed the infectious complications that occurred within 1 month after renal transplantation.
RESULTS
In Group A, most patients (62 cases, 95.3%) used a 1st generation cephalosporin. The incidence of wound infection after kidney transplant for the 65 patients who received prophylactic antibiotics was 1.5%, compared to 2.5% for the 41 patients who did not receive prophylactic antibiotics.
CONCLUSIONS
This retrospective study could not demonstrate a statistically significant difference in the rates of infectious complications between the two groups, although renal transplantation is considered to be a clean-contaminated surgery. But in order to obtain a definite conclusion, we need a bigger cohort in a prospective study.

Keyword

Kidney transplantation; Infection; Antibiotic prophylaxis

MeSH Terms

Anti-Bacterial Agents
Antibiotic Prophylaxis
Bacterial Infections
Cohort Studies
Humans
Incidence
Kidney
Kidney Transplantation
Korea
Retrospective Studies
Risk Assessment
Transplants
Wound Infection
Anti-Bacterial Agents

Reference

References

1). Rubin RH, Ikonen T, Gummert JF, Morris RE. The therapeutic prescription for the organ transplant recipient: the linkage of immunosuppression and antimicrobial strategies. Transpl Infect Dis. 1999; 1:29–39.

2). Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007; 357:26001–14.

3). Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006; 20:401–9.

4). Morris PJ, Knechtle SJ. Kidney transplantation: principles and practice. 6th ed.Philadelphia, PA: Saunders;2008.

5). Midtvedt K, Hartmann A, Midtvedt T, Brekke IB. Routine perioperative antibiotic prophylaxis in renal transplantation. Nephrol Dial Transplant. 1998; 13:1637–41.

6). Weber WP, Marti WR, Zwahlen M, Misteli H, Rosenthal R, Reck S, et al. The timing of surgical antimicrobial prophylaxis. Ann Surg. 2008; 247:918–26.

7). Veroux M, Giuffrida G, Corona D, Gagliano M, Scriffignano V, Vizcarra D, et al. Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc. 2008; 40:1873–6.

8). Kim SH, Min SK, Ahn MS, Huh S, Ha JW, Chung JK, et al. Infections of renal transplantation recipients in cyclosporin era. J Korean Soc Transplant. 1999; 13:269–76. (김성훈, 민승기, 안문상, 허승, 하종원, 정중기 등. 사이클로스포린을 사용한 신이식 환자에서의 감염증. 대한이식학회지 1999;13: 269–76.).

9). Fishman JA, Rubin RH. Infection in organ-transplant recipients. N Engl J Med. 1998; 338:1741–51.

10). Dantas SR, Kuboyama RH, Mazzali M, Moretti ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect. 2006; 63:117–23.

11). Warren JW, Platt R, Thomas RJ. Rosner B, Kass EH. Antibiotic irrigation and catheter-associated urinary-tract infections. N Engl J Med. 1978; 299:570–3.

12). Koo TY, Park HS, Kim HC, Park JS, Lee CH, Kim GH, et al. Infectious complications in patients with kidney transplantation: follow-up results in single center. J Korean Soc Transplant. 2008; 22:77–84. (구태연, 박혜선, 김현철, 박준성, 이창화, 김근호 등. 신장이식 후 발생하는 감염 합병증: 단일 기관 성적. 대한이식학회지 2008;22: 77–84.).

13). Hwang EA, Lee KT, Park KD, Park SB, Kim HC, Cho WH, et al. Infections following renal transplantation: long term follow-up study in single center. Korean J Nephrol. 2000; 19:713–23. (황은아, 이기태, 박경대, 박성배, 김현철, 조원현 등. 신이식 후 감염증: 장기 추적성적. 대한신장학회지 2000;19: 713–23.).

14). Stephan RN, Munschauer CE, Kumar MS. Surgical wound infection in renal transplantation: outcome data in 102 consecutive patients without perioperative systemic antibiotic coverage. Arch Surg. 1997; 132:1315–8. discussion 1318–9.

15). Ramos A, Asensio A, Muñez E, Torre-Cisneros J, Montejo M, Aguado JM, et al. Incisional surgical site infection in kidney transplantation. Urology. 2008; 72:119023.

16). Maraha B, Bonten H, van Hooff H, Fiolet H, Buiting AG, Stobberingh EE. Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect. 2001; 7:619–25.

17). Rubin RH, Schaffner A, Speich R. Introduction to the Immunocompromised Host Society consensus conference on epidemiology, prevention, diagnosis, and management of infections in solid-organ transplant patients. Clin Infect Dis. 2001; 33(S1):S1–4.

18). Ko KS, Cho DO, Ahn JH, Lee TW, Ihm CG, Chang SG, et al. Infections after renal transplantation. Transplant Proc. 1994; 26:2072–4.

19). Capocasale E, Mazzoni MP, Tondo S, D'Errico G. Antimicrobial prophylaxis with ceftriaxone in renal transplantation. Prospective study of 170 patients. Chemotherapy. 1994; 40:435–40.

20). Cohen J, Rees AJ, Williams G. A prospective randomized controlled trial of perioperative antibiotic prophylaxis in renal transplantation. J Hosp Infect. 1988; 11:357–63.

21). Bratzler DW, Houck PM. Surgical Infection Prevention Guidelines Writers Work group. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004; 38:1706–15.

22). García VD, Keitel E, Almeida P, Santos AF, Becker M, Goldani JC. Morbidity after renal transplantation: role of bacterial infection. Transplant Proc. 1995; 27:1825–6.

23). Rabkin DG, Stifelman MD, Birkhoff J, Richardson KA, Cohen D, Nowygrod R, et al. Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc. 1998; 30:4314–6.

24). Screening of donor and recipient prior to solid organ transplantation. Am J Transplant. 2004; 4(S10):10–20.