de Jorge-Huerta Lucía, Silva José Tiago, Fernández-Ruiz Mario, Rodríguez-Goncer Isabel, Pérez-Jacoiste Asín M Asunción, Ruiz-Merlo Tamara, Heredia-Mena Carlos, González-Monte Esther, Polanco Natalia, San Juan Rafael, Andrés Amado, Aguado José María, López-Medrano Francisco
Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Madrid, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Transpl Infect Dis. 2024 Dec;26(6):e14354. doi: 10.1111/tid.14354. Epub 2024 Aug 13.
Infection remains a relevant complication after kidney transplantation (KT). A well-established strategy in modern medicine is the application of bundles of evidence-based practice in clinical settings. The objective of this study is to explore the application of a personalized bundle of measures aimed to reduce the incidence of infection in the first 12 months after KT.
A single-center prospective cohort of 148 patients undergoing KT between February 2018 and September 2019 that received an individualized infection prevention strategy was compared to a preintervention cohort (n = 159). The bundle comprised a review of the patient's immunization history, infection risk by country of origin, screening for latent tuberculosis infection (LTBI), antimicrobial prophylaxis, and immunological assessment. Individualized recommendations were accordingly provided at a scheduled visit at day +30 after transplantation.
The intervention cohort showed a higher compliance rate with the recommended vaccine schedule, screening for geographically restricted infections and LTBI, and intravenous immunoglobulin and vitamin D supplementation (p values <.001). The 1-year incidence rate of infection was lower in the intervention cohort (42.6% vs. 57.9%; p value = .037), as was the rate of infection-related hospitalization (17.6% vs. 32.1%; p value = .003) and the incidence of severe bacterial infection. There were no differences in graft rejection or mortality rates between groups.
A multifaceted intervention, including a bundle of evidence-based practices, enhanced compliance with recommended preventive measures and was correlated with a reduction in the 12-month incidence of infection after KT.
感染仍然是肾移植（KT）后一种相关的并发症。现代医学中一种成熟的策略是在临床环境中应用基于证据的实践束。本研究的目的是探索应用个性化的措施束，旨在降低肾移植后前12个月内感染的发生率。
将2018年2月至2019年9月期间接受个性化感染预防策略的148例接受肾移植的单中心前瞻性队列患者与干预前队列（n = 159）进行比较。该措施束包括对患者免疫接种史的审查、按原籍国划分的感染风险、潜伏性结核感染（LTBI）筛查、抗菌预防和免疫评估。在移植后第30天的预定随访中相应地提供个性化建议。
干预队列在推荐的疫苗接种计划、地理区域受限感染和LTBI筛查以及静脉注射免疫球蛋白和维生素D补充方面显示出更高的依从率（p值<.001）。干预队列中1年感染发生率较低（42.6%对57.9%；p值 =.037），感染相关住院率也较低（17.6%对32.1%；p值 =.003）以及严重细菌感染的发生率。两组之间在移植排斥或死亡率方面没有差异。
包括一系列基于证据的实践的多方面干预提高了对推荐预防措施的依从性，并与肾移植后12个月感染发生率的降低相关。
