Le Berre N, Ladrière M, Corbel A, Remen T, Durin L, Frimat L, Thilly N, Pulcini C
Dialysis and Transplantation Department, Université de Lorraine, CHRU-Nancy, Nephrology, F-54000, Nancy, France.
Plateforme d'Aide à la Recherche Clinique, Université de Lorraine, CHRU-Nancy, F-54000, Nancy, France.
Eur J Clin Microbiol Infect Dis. 2020 May;39(5):915-921. doi: 10.1007/s10096-019-03808-4. Epub 2020 Jan 4.
Our survey aimed to describe current prescribing practices for perioperative antibiotic prophylaxis in French kidney transplant centers. We conducted a nationwide cross-sectional clinical vignette-based survey that we sent via email to hospital practitioners involved in perioperative management of kidney transplant patients (KTR). Nearly half of practitioners contacted (182/427, 42.6%) were respondents. A total of 167 getting enough kidney transplant activity were eligible for the survey. The response rate was 50.7% (68/134) among interns and 33.8% (99/293) among seniors. Positive perfusion fluids (PF) cultures for methicillin-susceptible Staphylococcus aureus were associated with antibiotic prescribing in 35% of cases, with no difference in prescribing in patients with diabetes, obesity, or delayed graft function. Antibiotic prescribing was most frequent with Pseudomonas aeruginosa (67%) and Klebsiella pneumoniae strains producing extended spectrum β-lactamases (57%). About 77%, 16%, and 13% of respondents, respectively, reported the existence of local practice guidelines for surgical antibiotic prophylaxis, a standardized approach for antibiotic prescribing in case of positive kidney transplant PF cultures, and local practice guidelines for systematical antibiotic prophylaxis in the early post-transplant period. In France, antibiotic prophylaxis practices in the perioperative kidney transplant period are very heterogeneous. To prevent unnecessary prescribing and bacterial resistance, evidence-based practice guidelines should be developed.
我们的调查旨在描述法国肾脏移植中心围手术期抗生素预防的当前处方做法。我们开展了一项全国性的横断面临床病例调查，并通过电子邮件发送给参与肾脏移植患者（KTR）围手术期管理的医院从业者。近一半被联系的从业者（182/427，42.6%）进行了回复。共有167个有足够肾脏移植活动量的机构符合调查条件。实习生的回复率为50.7%（68/134），资深医生的回复率为33.8%（99/293）。对甲氧西林敏感金黄色葡萄球菌的阳性灌注液（PF）培养结果在35%的病例中与抗生素处方相关，在糖尿病、肥胖或移植肾功能延迟的患者中处方情况无差异。抗生素处方在铜绿假单胞菌（67%）和产超广谱β-内酰胺酶的肺炎克雷伯菌菌株（57%）感染时最为常见。分别约有77%、16%和13%的受访者报告存在手术抗生素预防的当地实践指南、肾脏移植PF培养阳性时抗生素处方的标准化方法以及移植后早期系统性抗生素预防的当地实践指南。在法国，肾脏移植围手术期的抗生素预防做法非常不一致。为防止不必要的处方和细菌耐药性，应制定循证实践指南。
