Cabrera Pierina, Centeno Alexandra, Revollo Jane, Camargo Jose F
Department of Pharmacy Services, Jackson Memorial Hospital, Miami, FL, USA.
Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA.
Transpl Infect Dis. 2019 Oct;21(5):e13150. doi: 10.1111/tid.13150. Epub 2019 Aug 13.
The use of preemptive antimicrobial therapy for recipients of donors with microbial growth on pre-transplant urine cultures remains poorly studied.
Single-center retrospective study of kidney transplant recipients of allografts from deceased donors with urine-only (ie, in absence of donor bacteremia) positive cultures (September 2011 to August 2015). Transplant outcomes, including donor-derived infections (DDI) within the first three months post transplant, were analyzed.
Of the 970 kidney transplants performed during the study period, urine cultures were obtained from all donors, and of these, 27 (2.8%) yielded growth. Twenty-nine (73%) recipients were treated preemptively after transplantation. All of the recipients of donors with urine cultures positive for Enterococcus, Pseudomonas, or Candida spp. received therapy whereas only one of seven recipients with urine cultures positive for Escherichia coli was treated (P < .0001). All E coli isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), which was given to all patients for Pneumocystis pneumonia (PCP) prophylaxis. Infection within 3 months was evident in 16 (40%) patients: 10 out of 29 (35%) in the preemptive group and 6 out of 11 (55%) in the not-treatment group (P = .29). Evidence of DDI occurred in two recipients, one in each group. There were no differences in one-year graft and patient survival between groups.
Preemptive antibiotic therapy did not seem to impact transmission events and transplant outcomes in this small cohort. Low transmission rates might have been influenced by administration of PCP prophylaxis and universal preemptive therapy for positive donor urine cultures with virulent organisms. Larger studies are needed.
对于移植前尿培养有微生物生长的供体受者，采用抢先抗菌治疗的研究仍较少。
对2011年9月至2015年8月间接受来自已故供体的同种异体肾移植受者进行单中心回顾性研究，这些供体仅尿培养阳性（即无供体菌血症）。分析移植结局，包括移植后前三个月内的供体源性感染（DDI）。
在研究期间进行的970例肾移植中，对所有供体均进行了尿培养，其中27例（2.8%）有微生物生长。29例（73%）受者在移植后接受了抢先治疗。尿培养中肠球菌、铜绿假单胞菌或念珠菌属阳性的供体的所有受者均接受了治疗，而7例尿培养大肠杆菌阳性的受者中只有1例接受了治疗（P <.0001）。所有大肠杆菌分离株对甲氧苄啶-磺胺甲恶唑（TMP-SMX）敏感，所有患者均接受该药预防肺孢子菌肺炎（PCP）。16例（40%）患者在3个月内出现感染：抢先治疗组29例中有10例（35%），未治疗组11例中有6例（55%）（P =.29）。两组各有1例受者出现DDI证据。两组间1年移植物和患者生存率无差异。
在这个小队列中，抢先抗生素治疗似乎并未影响传播事件和移植结局。低传播率可能受到PCP预防用药以及对具有毒性微生物的供体尿培养阳性进行普遍抢先治疗的影响。需要开展更大规模的研究。
