Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Transplantation. 2018 Jan;102(1):21-34. doi: 10.1097/TP.0000000000001848.
Antibiotic prophylaxis in the perioperative period is the standard of care for nearly all surgical procedures and routinely prescribed during solid organ transplantation (SOT). The primary goal of perioperative antibiotic prophylaxis is to minimize postoperative surgical site infections (SSIs). SSIs are a significant issue in SOT. Depending on the organ transplanted, SSIs occur in 3% to 53% of patients, with the highest rates observed in small bowel/multivisceral, liver, and pancreas transplant recipients. SOT recipients are also at increased risk of developing SSIs with antimicrobial-resistant organisms. In this article, we describe the epidemiology and risk factors for SSIs in SOT and examine the available literature to guide the use of different regimens for perioperative antibiotic prophylaxis for each organ. We have further addressed specific situations that are unique to each organ transplant type, such as the use of extracorporeal membrane oxygenation in thoracic organ transplantation, as well as an approach to perioperative antibiotic prophylaxis in the setting of recipient and/or donor infection before transplantation. We provide potential approaches to the selection, dosing, and duration of perioperative antibiotic prophylaxis for each of these clinical situations.
围手术期抗生素预防是几乎所有手术的标准治疗方法，在实体器官移植（SOT）中常规使用。围手术期抗生素预防的主要目的是最大限度地减少术后手术部位感染（SSI）。SSI 是 SOT 中的一个重要问题。根据移植的器官不同，SSI 发生在 3%至 53%的患者中，小肠/多脏器、肝和胰腺移植受者中观察到的发生率最高。SOT 受者也有发生感染抗微生物药物耐药菌的 SSI 的风险增加。在本文中，我们描述了 SOT 中 SSI 的流行病学和危险因素，并研究了现有文献，以指导每种器官围手术期抗生素预防方案的使用。我们还针对每种器官移植类型的特定情况，如胸器官移植中体外膜氧合的使用，以及受体和/或供体在移植前感染时围手术期抗生素预防的方法，进一步讨论了具体的方法。我们为这些临床情况中的每一种提供了围手术期抗生素预防的选择、剂量和持续时间的潜在方法。
