Risk Factors for Nosocomial Urinary Tract and Postoperative Wound Infections in Renal Transplant Patients: A Matched-Pair Case-Control Study

Abstract

A matched-pair case-control study was done on 4 groups of renal transplant patients who acquired nosocomial infections: 1) urinary tract infection, 2) postoperative wound infection, 3) urinary tract plus postoperative wound infection and 4) the entire group of patients. For urinary tract infection patients a prolonged period of hemodialysis before hospitalization was considered a risk factor. Renal transplantation with an HLA-1 (identical) donor graft was a characteristic related to the control group. High levels of plasma creatinine and prolonged vesical catheterization were risk factors for acquiring postoperative wound infection. The latter was also considered to be a risk factor for both infections, as well as the inadequate use of antibiotic prophylaxis and the number of antibiotics used. For the entire group of patients surgical wall hematoma was a risk factor. In this group the independent risk factors analyzed by multivariate logistic regression were renal transplantation with a cadaver donor graft, prolonged vesical catheterization and prolonged use of antibiotics. Careful management of the cadaver donor allograft, decreasing the changes of contamination, decreasing the interval of urinary catheter maintenance and use of antibiotics in the postoperative period are measures that can contribute to lessen the incidence of these nosocomial infections in renal transplant recipients.

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“…Reoperation is reportedly a major risk factor for SIIs, most likely because of the contamination due to repeated handling of the surgical site. 25 On the contrary, our results did not confirm that female sex and sirolimus use could lead to increased frequency of SII, 26 since in our series none of the patients in the SII group received sirolimus and men far outnumbered women.…”

Emerging Infections in Renal Transplant Recipients. What has Changed in Recent Decades?

“…However immunosuppression creates an inseparable connection between infection and rejection, a fact that is very important for the transplantation teams, demonstrating that immunosuppression protocols should be flexible and not just focused on the graft, but the immunological, socioeconomic, geographic conditions and in the presence of comorbidities of renal allograft recipients. It is indisputable that the rate of infection is associated with the total increase of doses, the number of drugs used and the use of monoclonal antibodies in repeated episodes of rejection [3].Concerning the prevalence and types of the most common infections in the first six months of postoperative are classic and already well-studied [4]. The major focus of the transplant is currently facing emerging and endemic infections coming affecting the patients receiving renal transplantation.…”

“…The major focus of the transplant is currently facing emerging and endemic infections coming affecting the patients receiving renal transplantation. Infections still unknown, there are few studies in the literature which complicates the diagnosis and therefore treatment, endangering patients and renal grafts [4].In this large group of emerging agents, quoted infections caused by polyomavirus BK, which has been identified with high frequency and due to its histological characteristics to affect the renal graft mimics episode of acute rejection and is one of the factors responsible for chronic rejection renal graft. Still among viral infections, let us not forget the human parvovirus B19 causing aplastic anaemia and microangiopatics phenomena in renal graft [5].…”

“…Concerning the prevalence and types of the most common infections in the first six months of postoperative are classic and already well-studied [4]. The major focus of the transplant is currently facing emerging and endemic infections coming affecting the patients receiving renal transplantation.…”

“…The major focus of the transplant is currently facing emerging and endemic infections coming affecting the patients receiving renal transplantation. Infections still unknown, there are few studies in the literature which complicates the diagnosis and therefore treatment, endangering patients and renal grafts [4].…”