Ostaszewska Agata, Wszola Michal, Olszewska Natalia, Karpeta Edyta, Serwanska-Swietek Marta, Kuthan Robert, Kawecki Dariusz, Berman Andrzej, Domagała Piotr, Kwiatkowski Artur, Chmura Andrzej
Department of General and Transplantation Surgery, Warsaw Medical University, Warsaw, Poland; Foundation of Research and Science Development, Otwock, Poland.
Foundation of Research and Science Development, Otwock, Poland.
Transplant Proc. 2019 Oct;51(8):2724-2730. doi: 10.1016/j.transproceed.2019.05.018. Epub 2019 Aug 30.
One of the most common infective complications after kidney transplant (KTx) is surgical site infection (SSI). Providing indications of improvement of perioperative antibiotic prophylaxis (PAP) and allowing the characterization of risk factors are critical to reduce SSI. The purpose of this study was to evaluate the SSI risk factors and impact of reoperation in the early post-transplant period on SSI occurrence and assess if standard PAP in those cases is a best consideration.
Between April 2014 and October 2015, a total of 236 KTxs were performed in our center. Deceased donor data, recipient data, and data related to surgical procedures were collected.
Surgical site infections were reported in 5.6% (12/214) of patients. Seven patients were diagnosed as having superficial SSI (7/12; 58.3%), 2 with deep SSI (2/12; 16.6%), and 4 with organ-specific SSI (4/12; 33.3%). Extended criteria donor-related transplant, cold ischemia time > 22 hours, dialysis period > 30 months, recipient age older than 45 years, recipient body mass index > 27, induction therapy prior to transplant, diabetes prior to transplant, and ≥ 1 reoperation during 30 days of observation were independent risk factors of SSI occurrence. A total of 19 reoperations were performed in 17 patients. In 8 of all 12 patients with SSI diagnosis, the reoperation was performed (66.7%). In 202 patients of non-SSI patients, only 9 reoperations were performed (4.5%).
Early reoperation after Ktx is a strong risk factor of SSI occurrence. There is a probability that > 4 SSI risk factors and reoperation in the early post-transplant period could require different and more aggressive proceeding, as standard PAP in those cases is insufficient.
肾移植（KTx）术后最常见的感染性并发症之一是手术部位感染（SSI）。提供围手术期抗生素预防（PAP）改善的指标并确定危险因素对于降低SSI至关重要。本研究的目的是评估SSI的危险因素以及移植后早期再次手术对SSI发生的影响，并评估在这些情况下标准PAP是否是最佳选择。
2014年4月至2015年10月期间，我们中心共进行了236例KTx手术。收集了已故供体数据、受体数据以及与手术相关的数据。
5.6%（12/214）的患者报告发生了手术部位感染。7例患者被诊断为浅表SSI（7/12；58.3%），2例为深部SSI（2/12；16.6%），4例为器官特异性SSI（4/12；33.3%）。扩大标准供体相关移植、冷缺血时间>22小时、透析期>30个月、受体年龄>45岁、受体体重指数>27、移植前诱导治疗、移植前糖尿病以及观察期30天内≥1次再次手术是SSI发生的独立危险因素。17例患者共进行了19次再次手术。在所有12例SSI诊断患者中，8例进行了再次手术（66.7%）。在202例非SSI患者中，仅进行了9次再次手术（4.5%）。
KTx术后早期再次手术是SSI发生的一个强有力的危险因素。移植后早期存在>4个SSI危险因素且进行再次手术可能需要不同且更积极的处理措施，因为在这些情况下标准PAP是不够的。
