Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
Transpl Infect Dis. 2020 Jun;22(3):e13261. doi: 10.1111/tid.13261. Epub 2020 Feb 24.
Infection prevention and timely and effective treatment are among the major aims of care in kidney transplant recipients. Pre-transplant vaccination and pre-transplant viral screening have been extensively studied and are now considered standard practice. Early post-operative infection surveillance is mandatory in other vulnerable cohorts, but has not been extensively studied in this population. We hypothesized that surveillance of the most common bacterial infection types in the post-transplant setting would be beneficial and identify key areas for improvement.
All adult kidney transplant recipients whose surgeries were performed in the Irish national kidney transplant unit over a 1-year period had prospective early post-transplant (first 30 days) infection surveillance in 2014 for surgical site infection, urinary tract infection, and secondary bloodstream infections (Group T0). Several key changes were implemented following scrutiny of infection patterns and clinical practice. Subsequently, infection surveillance was undertaken for 2016 and 2017 (Group T1) to assess the impact of these changes.
Between 2014 and 2017, the number of kidney transplants increased by 32%. The following aspects of clinical practice were the focus of change following analysis of Group T0 data: timing of surgical antimicrobial prophylaxis (SAP) administration, choice of SAP antimicrobial agent, and routine microbiological testing in the peri-operative period. Following implementation of these changes, the timing of SAP administration was greatly improved (45%-100% of cases appropriately timed). The infection rate decreased from 8.9% to 7.4% in 2016, with a further decrease to 4% in 2017 (OR 0.42 (95% CI: 0.16-1.10); P = .08). Compliance with pre-operative microbiological screening improved in Group T1.
Simple clinical practice changes, implemented upon analysis of common bacterial infection surveillance data in the first 30 days after kidney transplantation resulted in more effective SAP administration and improved compliance with routine microbiological testing in the peri-operative period. These interventions have potentially contributed to reduced early post-operative infection rates, despite increased transplant activity in the unit. Infection surveillance is an important and under-utilized way of reducing infections in this vulnerable patient cohort.
预防感染和及时有效的治疗是肾移植受者护理的主要目标之一。移植前疫苗接种和移植前病毒筛查已得到广泛研究，现在被认为是标准做法。在其他易感染人群中，术后早期感染监测是强制性的，但在该人群中尚未得到广泛研究。我们假设对移植后最常见的细菌感染类型进行监测将是有益的，并确定需要改进的关键领域。
2014 年，在爱尔兰国家肾移植单位进行手术的所有成年肾移植受者在术后 30 天内进行了前瞻性早期（第 0 天）感染监测，包括手术部位感染、尿路感染和继发性血流感染（T0 组）。在审查了感染模式和临床实践之后，对以下几个关键方面进行了修改。随后，在 2016 年和 2017 年进行了感染监测（T1 组），以评估这些变化的影响。
2014 年至 2017 年，肾移植数量增加了 32%。在分析 T0 组数据后，临床实践的以下方面是变化的重点：手术抗菌预防（SAP）给药的时间、SAP 抗菌药物的选择以及围手术期的常规微生物学检测。在实施这些变化后，SAP 给药的时间大大改善（45%-100%的病例均按时给药）。2016 年感染率从 8.9%降至 7.4%，2017 年进一步降至 4%（OR 0.42（95%CI：0.16-1.10）；P=0.08）。T1 组术前微生物筛查的依从性提高。
在肾移植后 30 天内对常见细菌感染监测数据进行分析后，实施简单的临床实践改变，使 SAP 给药更加有效，并提高了围手术期常规微生物检测的依从性。这些干预措施可能有助于降低早期术后感染率，尽管该单位的移植活动增加。感染监测是减少这一脆弱患者群体感染的重要且未充分利用的方法。
