肾移植术后阿米卡星预防和手术部位感染的危险因素。

Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation.

机构信息

1 Hospital Epidemiology and Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 2 Renal Transplantation Service, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 3 Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.

出版信息

Transplantation. 2015 Mar;99(3):521-7. doi: 10.1097/TP.0000000000000381.

DOI:10.1097/TP.0000000000000381

PMID:25254907

Abstract

BACKGROUND

Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs.

METHODS

We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation.

RESULTS

A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function.

CONCLUSION

Amikacin prophylaxis is a useful strategy for preventing SSIs.

摘要

背景

抗生素预防在预防手术部位感染（SSI）中起着重要作用。本研究旨在评估肾移植中抗生素预防的作用，并确定 SSI 的危险因素。

方法

我们评估了 2009 年 1 月至 2012 年 12 月期间所有接受肾移植的患者。排除了在移植后 72 小时内死亡、同时接受另一个器官移植或年龄小于 12 岁的患者。主要观察指标是移植后 60 天内的 SSI。

结果

共评估了 819 例肾移植患者，其中 65%接受了已故供者的肾脏。用于预防的抗生素包括头孢菌素，在 576 例（70%）中，阿米卡星，在 233 例（28%）中。我们发现 106 例（13%）患者发生 SSI，其中 72 例（68%）确定了病原体。在分离的细菌中，产超广谱β-内酰胺酶的肠杆菌科感染占主导地位。多变量分析显示，肾移植后 SSI 的危险因素包括已故供者、肾移植时输尿管细、抗胸腺细胞球蛋白诱导治疗、移植过程中的输血、高体重指数和糖尿病。唯一与 SSI 发生率降低相关的因素是阿米卡星作为抗生素预防的使用。与移植物存活率降低相关的因素包括：术中输血、再次手术、人类白细胞抗原不匹配、使用非标准免疫抑制治疗、已故供者、肾移植后 SSI 和延迟移植物功能。