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Perioperative antibiotic prophylaxis in renal transplantation: a single-center comparison between two regimens and a brief survey among the Eurotransplant renal transplantation centers

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Abstract

Background

Perioperative antibiotic prophylaxis (PAP) is an integral part of kidney transplantation to prevent surgical site infections (SSI). In July 2015, we changed our standard from a multiple-dose to a single-dose (SD) prophylaxis. Here, we report on results with both regimens and a related survey among Eurotransplant renal transplantation centers.

Methods

From July 2015, all kidney graft recipients of our center were scheduled to receive SD i.v. cefazolin (group SD, n = 107). They were compared to patients, transplanted since January 2014, receiving our previous standard (i.v. piperacillin/flucloxacillin) until postoperative day (POD) 7, plus oral sultamicillin until POD 10 (group MD, n = 105). The primary endpoint was the number of SSIs during a 3-month observational period.

Results

The frequency of SSI episodes was generally low (group SD vs. MD: 2 vs. 4, p = 0.40). Of note, urinary tract infections occurred in 40 SD vs. 36 MD patients, respectively (p = 0.60). Urinary tract infections were caused by Escherichia coli in 36.8%. Female gender was the only independent risk factor on multivariate analysis (p = 0.002). In addition, 12 episodes of urosepsis in both groups occurred. All-cause infection with multi-resistant bacteria occurred less frequently in SD vs. MD patients (3.7% vs. 8.6%, p = 0.16). A majority of Eurotransplant centers used i.v. single-dose cephalosporins (36.9%), although substances and duration varied remarkably.

Conclusion

Single-dose cefazolin was equally effective and less expensive compared to our previous MD regimen. Based on these findings, we conclude that future prospective studies should be designed to confirm the non-inferiority of single-dose antibiotic regimens.

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Abbreviations

ABMR:

Antibody-mediated rejection

AB0i:

AB0-incompatible

DGF:

Delayed graft function

EAU:

European Association of Urology

ITT:

Intention-to-treat

MDR:

Multidrug-resistant

MRGN:

Multidrug-resistant Gram-negative

NODAT:

New onset diabetes after transplantation

PAP:

Perioperative antibiotic prophylaxis

POD:

Postoperative day

PP:

Per-protocol

SSI:

Surgical site infection

UTI:

Urinary tract infection

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Acknowledgements

We are grateful to our colleagues from all Eurotransplant centers, who participated in our survey.

Funding

The authors received no funding for this work.

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Authors and Affiliations

  1. Department of Nephrology and Medical Intensive Care, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Friederike Bachmann, Lutz Liefeldt, Torsten Slowinski, Klemens Budde & Johannes Waiser

  2. Department of Microbiology, Labor Berlin GmbH, Berlin, Germany

    Thomas Adam

  3. Department of Urology, Charité University Medicine Berlin, Berlin, Germany

    Frank Friedersdorff

Authors
  1. Friederike Bachmann
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  2. Thomas Adam
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  3. Frank Friedersdorff
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  4. Lutz Liefeldt
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  5. Torsten Slowinski
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  6. Klemens Budde
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  7. Johannes Waiser
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Contributions

Friederike Bachmann and Johannes Waiser: conception, data acquisition, data analysis, preparation and writing of the manuscript. Thomas Adam: conception, data analysis, and critical revision of the manuscript. Frank Friedersdorff: transplant surgery, and critical revision of the manuscript. Lutz Liefeldt, and Torsten Slowinski: critical revision of the manuscript. Klemens Budde: conception, critical revision and final approval of the manuscript.

Corresponding author

Correspondence to Friederike Bachmann.

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Bachmann, F., Adam, T., Friedersdorff, F. et al. Perioperative antibiotic prophylaxis in renal transplantation: a single-center comparison between two regimens and a brief survey among the Eurotransplant renal transplantation centers. World J Urol 37, 957–967 (2019). https://doi.org/10.1007/s00345-018-2440-2

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  • DOI: https://doi.org/10.1007/s00345-018-2440-2

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