Clinical impact of bacterial contamination of perfusion fluid in kidney transplantation

Diena, Davide; Simonato, Francesca; Messina, M.; Burdese, Manuel; Piraina, Valentina; Fop, Fabrizio; Segoloni, Giuseppe; Biancone, Luigi

doi:10.1186/s40064-015-1658-3

Cited by 23 publications

(18 citation statements)

References 17 publications

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“…In our study, PF-related infections were detected in only 1.3% of all SOT recipients with culture-positive PF, although the rate increased to 8.5% in the case of SOT recipients with high-risk culture-positive PF without PE-T. These rates are consistent with previous reports [17–20]. The high incidence of culture-positive PF and the low rate of PF-related infection are the reasons why some authors do not recommend routine PF culture; they argue that the benefit of treatment is low and that the risk of selecting resistant microorganisms may be increased [15, 21].…”

Section: Discussionsupporting

confidence: 93%

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Oriol

Sabé

Càmara

et al. 2019

Open Forum Infectious Diseases

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Background We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. Methods From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. Results The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered “high risk” for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid–related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. Conclusions The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid–related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

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Section: Discussionsupporting

confidence: 93%

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

Oriol

Sabé

Càmara

et al. 2019

Open Forum Infectious Diseases

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“…Some transplant centers do not culture preservation fluid. 8 Of the transplant centers that do screen the preservation fluid, there is a wide variance in the incidence of positive fluid cultures of 5 to 62.5%. 2– 4,8,9 Although there are some cases of systemic infection linked to Escherichia coli and Klebsiella pneumoniae , the definitive association of an infection with a positive preservation culture was rare.…”

Section: Introduction/backgroundmentioning

confidence: 99%

The Significance and Impact of Screening Preservation Fluid Cultures in Renal Transplant Recipients

et al. 2020

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Introduction: Infectious complications can be a major cause of morbidity and mortality in solid organ transplant recipients. Preservation fluid is necessary to maintain organ viability but may serve as a vector or infection. The utility of screening preservation fluid routinely for microbial growth and the impact of culture-positive preservation fluid is controversial. Research Question: What is the clinical impact of a culture positive preservation fluid in a kidney transplant recipient? Design: This retrospective study was performed to define the incidence of post-operative infection related to PF and examine the negative sequelae of culture-positive PF. One hundred and fifty-two deceased donor renal transplant recipients from January 2015 to December 2017 were included for analysis. Results: Overall, 67% of patients (102/152) received an allograft from a culture-positive PF. Nearly 80% of microbial growth was consistent with skin flora, and coagulase-negative staphylococci was the most frequently isolated organism (56%). Sixty-seven percent of patients (68/102) with culture-positive PF received antimicrobial treatment for an average duration of 5 days. There was no difference in the incidence of infection between patients with culture positive PF compared to culture-negative PF. Furthermore, there were no cases of infection related to PF regardless of whether culture-positive PF was treated or untreated. The incidence of subsequent C. difficile infection and multidrug-resistant organisms was similar. Discussion: This study suggests antimicrobial treatment for culture positive PF may not be necessary with pathogens that are common contaminants and of low virulence. Interventional studies are needed to validate this strategy.

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“…In the remaining 24 cases, including those where Candida albicans was cultured from the perfusion fluid, preemptive therapy was not utilized. It is our practice, based on this local data and international experience, to closely monitor the patient both clinically and microbiologically and institute treatment only if evidence of infection, providing individualized patient care, and avoidance of unnecessary antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of common infections in the early period after renal transplantation in a national center: 2014‐2017

Connell

Kennedy

Skally

et al. 2020

Transplant Infectious Dis

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Background 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. Methods 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. Results 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. Conclusions 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.

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Clinical impact of bacterial contamination of perfusion fluid in kidney transplantation

Cited by 23 publications

References 17 publications

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study

The Significance and Impact of Screening Preservation Fluid Cultures in Renal Transplant Recipients

Surveillance of common infections in the early period after renal transplantation in a national center: 2014‐2017

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