Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients

Abstract

Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasion require management with negative pressure wound therapy (NPWT). This is often successful, with a low risk of further complications. However, we describe three cases in which persistent or recurrent surgical site sepsis occurred, whilst NPWT was being deployed in adults with either wound dehiscence or initial SSI. This type of complication in the setting of NPWT has not been previously described in renal transplant recipients. Our case series demonstrates that in immunosuppressed transplant recipients, there may be ineffective microbial or bacterial bioburden clearance associated with the NPWT, which can lead to further infections. Hence recognition for infections in renal transplant patients undergoing treatment with NPWT is vital; furthermore, aggressive management of sepsis control with early debridement, antimicrobial use, and reassessment of the use of wound dressing is necessary to reduce the morbidity associated with surgical site infections and NPWT.

Negative pressure wound therapy for surgical site infections: A systematic review and meta‐analysis

“…Because there were some differences in wound healing outcome measures across the included studies, we expressed the effect of NPWT on SSI healing by wound healing time and rate. The results show that NPWT promotes SSI healing, which is consistent with previous findings (Kim & Kang, 2020; Lam et al, 2019). This is mainly attributable to NPWT's ability to not only remove pus in a timely manner but to also further influence local tissue repair via local negative pressure.…”

Adapting surgical ‘bundles’ to prevent surgical site infections in obstetrics and gynecology (Review)

“…Negative pressure reduces the fluid accumulation and the frequency of dressing changes to every 3-5 days (37). Although there are reports that VAC does not reduce the bacterial bioburden, most cases treated this way healed without incidents potentially because the foam reacts similar to a foreign body and generates an inflammatory reaction in the surgical site, and fails to reduce the extent of bacterial colonization (38)(39)(40).…”

A clinical case of the successful VAC therapy in a patient with surgical wound infection after kidney transplantation

“…В зарубежной литературе встречаются единичные сообщения о клиническом применении VAC-терапии для лечения инфицированных ран после трансплантации почки [13,[17][18][19]. В отечественных публикациях такой опыт не описан.…”