Lee Sang Ah, Kim Jin-Myung, Kwon Hye Eun, Ko Youngmin, Jung Joo Hee, Shin Sung, Kim Young Hoon, Kim Sung-Han, Kwon Hyunwook
Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
PLoS One. 2025 Nov 21;20(11):e0337578. doi: 10.1371/journal.pone.0337578. eCollection 2025.
Optimal perioperative antibiotic prophylaxis in kidney transplantation remains undefined despite routine antibiotic administration to prevent infections. In this retrospective observational cohort study with historical comparison, we compared the clinical efficacy of 6 days of ampicillin/sulbactam vs. a single dose of cefazolin.
We retrospectively analyzed 2322 kidney transplantation recipients at a single center, with the evaluation period spanning from 2015 through 2021. Patients were divided into 2 groups based on the perioperative antibiotic regimen received: 971 patients received ampicillin/sulbactam, and 1351 received cefazolin. This study focused on evaluating the impact of these regimens on postoperative infection incidence and the 6-month acute rejection (AR) rates.
The cefazolin group exhibited a tendency toward higher urinary tract infection rates within 1 month after transplantation (3.4% vs. 2.2%, p= = 0.078). There were no significant differences in surgical site infections between the groups. The 6-month AR rates were significantly lower in the cefazolin group than in the ampicillin/sulbactam group (5.1% vs. 7.9%, p= = 0.009). Cefazolin was also confirmed to be significantly associated with reduced 6-month AR rates in the multivariable logistic regression analysis (odds ratio 0.63, 95% confidence interval [0.45-0.89], p= = 0.009).
In this study, we observed that a single dose of cefazolin as perioperative antibiotic prophylaxis may lead to higher rates of postoperative urinary tract infections, but it could potentially lower the incidence of acute rejection within six months.
尽管为预防感染而常规使用抗生素，但肾移植围手术期的最佳抗生素预防方案仍不明确。在这项具有历史对照的回顾性观察队列研究中，我们比较了6天氨苄西林/舒巴坦与单剂量头孢唑林的临床疗效。
我们回顾性分析了单中心的2322例肾移植受者，评估期为2015年至2021年。根据围手术期接受的抗生素方案将患者分为两组：971例患者接受氨苄西林/舒巴坦，1351例接受头孢唑林。本研究重点评估这些方案对术后感染发生率和6个月急性排斥反应（AR）率的影响。
头孢唑林组在移植后1个月内的尿路感染率有升高趋势（3.4%对2.2%，p = 0.078）。两组手术部位感染无显著差异。头孢唑林组的6个月AR率显著低于氨苄西林/舒巴坦组（5.1%对7.9%，p = 0.009）。在多变量逻辑回归分析中，头孢唑林也被证实与降低6个月AR率显著相关（优势比0.63，95%置信区间[0.45 - 0.89]，p = 0.009）。
在本研究中，我们观察到单剂量头孢唑林作为围手术期抗生素预防可能导致术后尿路感染率升高，但可能会降低六个月内急性排斥反应的发生率。
