Englbrecht Jan Sönke, Bracht Hendrik, Gehrenkemper Julian Philip, Borgstedt Rainer, Witzke Dominic, Gottschalk Antje, Lanckohr Christian
Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Münster, Albert-Schweitzer-Campus, 48149 Münster, Germany.
Department of Anesthesiology, Intensive Care, Emergency and Transfusion Medicine and Pain Therapy, University Protestant Hospital Bielefeld Bethel, Campus Bielefeld-Bethel, 33617 Bielefeld, Germany.
J Crit Care. 2025 Dec;90:155196. doi: 10.1016/j.jcrc.2025.155196. Epub 2025 Jul 21.
Adequate donor management is essential to increase the number of transplantable organs. No specific recommendations about anti-infective management for organ donors are available and the sparse literature indicates that antimicrobials are used too liberally. We analyzed anti-infective management of brain-dead donors to add to the limited evidence.
All brain-dead donors at the University Hospitals Münster (2010-2024) and Bielefeld Bethel (2020-2024) were retrospectively included. The use and indication of antimicrobials, microbiological diagnostics and inflammatory markers were assessed during intensive care unit stay and organ retrieval.
149 donors were included, 76.5 % received antimicrobials in the intensive care unit and 21.5 % during organ retrieval. Antimicrobial exposure did not correlate between both periods. Indication for antimicrobials was documented in 61 % of donors, with aspiration pneumonia (33 %) and ventilator-associated pneumonia (33 %) being the most common diagnoses. Positive microbiological cultures were found in 36 % of donors but without correlation to antimicrobial exposure or length of exposure. The proportion of donors with out of normal range values for C-reactive protein (67-100 %), white blood cell count (53-88 %) and procalcitonin (22-43 %) was high, but only C-reactive protein differed between the day before and the day of brain death diagnosis and between infected and non-infected donors.
Antimicrobial use was high during intensive care unit stay, low during organ retrieval and inconsistent between both periods. Inflammatory markers were insufficient to indicate infection. Aggravated by a lack of evidence-based recommendations, this indicates inadequate anti-infective management of DBD donors, which may have a negative impact on the organ recipient.
充分的供体管理对于增加可移植器官数量至关重要。目前尚无关于器官供体抗感染管理的具体建议，且为数不多的文献表明抗菌药物使用过于随意。我们分析了脑死亡供体的抗感染管理情况，以补充有限的证据。
回顾性纳入明斯特大学医院（2010 - 2024年）和比勒费尔德贝特尔医院（2020 - 2024年）的所有脑死亡供体。在重症监护病房停留期间和器官获取过程中，评估抗菌药物的使用及指征、微生物诊断和炎症标志物。
共纳入149名供体，76.5%在重症监护病房接受了抗菌药物治疗，21.5%在器官获取期间接受了治疗。两个阶段的抗菌药物暴露情况无相关性。61%的供体记录了抗菌药物使用指征，其中吸入性肺炎（33%）和呼吸机相关性肺炎（33%）是最常见的诊断。36%的供体微生物培养呈阳性，但与抗菌药物暴露或暴露时间无关。C反应蛋白（67 - 100%）、白细胞计数（53 - 88%）和降钙素原（22 - 43%）超出正常范围值的供体比例较高，但只有C反应蛋白在脑死亡诊断前一天和诊断当天以及感染和未感染供体之间存在差异。
在重症监护病房停留期间抗菌药物使用频繁，器官获取期间使用较少，且两个阶段不一致。炎症标志物不足以表明感染情况。由于缺乏循证建议，这表明对脑死亡供体的抗感染管理不足，可能会对器官接受者产生负面影响。
