Cowan Juthaporn, Bennett Alexandria, Fergusson Nicholas, McLean Cheynne, Mallick Ranjeeta, Cameron D William, Knoll Greg
Division of Infectious Diseases, Department of Medicine, University of Ottawa, ON, Canada.
Clinical Epidemiology Program, The Ottawa Hospital Research Institute, ON, Canada.
Can J Kidney Health Dis. 2018 Sep 12;5:2054358118799692. doi: 10.1177/2054358118799692. eCollection 2018.
Reducing post-operative infections among kidney transplant patients is critical to improve long-term outcomes. With shifting disease demographics and implementation of new transplantation protocols, frequent evaluation of infection rate and type is necessary.
Our objectives were to assess the incidence and types of post-operative infections in kidney transplant recipients at a large tertiary-care facility and determine sample sizes needed for future intervention trials.
Retrospective cohort study.
The Ottawa Hospital, Ottawa, Ontario.
Adult kidney transplant patients, N = 142.
Demographic data, transplant protocol, infections up to 2 years following transplantation.
Infections within 2 years following transplantation in all kidney transplant recipients between January 2011 and December 2012 were reviewed. Sample sizes were determined using all-cause infection rates and infection-free survival data.
Of 142 patients, 44 (31.0%) had at least one infection. The incidence of infection was 36.2 per 100 patient-years by 2 years post-transplant. A total of 32 (22.5%) patients had 56 infection-related hospitalizations with 73.2% occurring in the first year. In the first 2 years, urinary tract infections had the highest incidence (18.1 per 100 patient-years) followed by skin (3.9 per 100 patient-years), cytomegalovirus (3.9 per 100 patient-years), and bacteremia (3.9 per 100 patient-years). Results indicate that 206 patients per study arm would be needed to show a 30% reduction in the 2-year incidence of infection post-transplantation.
Infection rates may be slightly underestimated due to the relatively short 2-year follow-up; however, the highest infection-risk period was captured within this time frame.
Infections post-kidney transplant are still common, particularly urinary tract infections. They are associated with significant morbidity and hospitalization. Given the feasible sample sizes calculated in this study, intervention trials are indicated to further reduce infection rates within the first 2 years post-kidney transplantation.
降低肾移植患者术后感染对于改善长期预后至关重要。随着疾病人口结构的变化以及新移植方案的实施，有必要对感染率和感染类型进行频繁评估。
我们的目的是评估一家大型三级医疗机构中肾移植受者术后感染的发生率和类型，并确定未来干预试验所需的样本量。
回顾性队列研究。
安大略省渥太华市的渥太华医院。
成年肾移植患者，N = 142。
人口统计学数据、移植方案、移植后2年内的感染情况。
回顾2011年1月至2012年12月期间所有肾移植受者移植后2年内的感染情况。使用全因感染率和无感染生存数据确定样本量。
142例患者中，44例（31.0%）至少发生过一次感染。移植后2年时，感染发生率为每100患者年36.2例。共有32例（22.5%）患者因感染住院56次，其中73.2%发生在第一年。在最初2年中，尿路感染发生率最高（每100患者年18.1例），其次为皮肤感染（每100患者年3.9例）、巨细胞病毒感染（每100患者年3.9例）和菌血症（每100患者年3.9例）。结果表明，每个研究组需要206例患者才能显示移植后2年感染发生率降低30%。
由于随访时间相对较短，感染率可能略有低估；然而，在此时间范围内捕捉到了最高感染风险期。
肾移植后感染仍然很常见，尤其是尿路感染。它们与显著的发病率和住院率相关。鉴于本研究计算出的可行样本量，有必要进行干预试验以进一步降低肾移植后最初2年内的感染率。
