Wound Infections in Renal Transplant Patients

Abstract

During a 33-month interval 106 consecutive renal transplants were performed. Prophylactic parenteral antibiotics, local wound irrigation with antibiotic solutions and drains were used. The over-all incidence of wound infection was 11.3 per cent. The true incidence in primary wounds was 8.4 per cent and in reopened wounds it was 21.7 per cent. Graft loss owing to infection was 33.3 per cent. Sepsis occurred in 25 per cent and death in 16.6 per cent of the patients with wound infection. The incidence of infections in hematomas was 27.5 per cent. The use of prophylactic measures contributed to a lower incidence of wound infection, while the use of drains and the occurrence of hematomas increased the incidence of infections.

Clinical practice guidelines for antimicrobial prophylaxis in surgery

“…998 The rate of postoperative infection after this procedure has been reported to range from 10% to 56%, with the two most common infections being UTIs and SSIs. 1004,[1014][1015][1016][1017][1018][1019][1020][1021][1022][1023][1024] Graft loss due to infection occurs in up to 33% of cases. 1017,1023 One study of adult and pediatric kidney transplant recipients (both living-related and cadaveric donor sources) found patient survival rates at 7 years after transplantation of 88.9% and 75.5%, respectively, and graft survival of 75% and 55.5%, respectively.…”

“…Mortality associated with postoperative infections is substantial and ranges from approximately 5% to 30%. 1015,1017,1019,1022,1026,1027 The frequency of SSIs in kidney transplant recipients has ranged from 0% to 11% with antimicrobial prophylaxis [1023][1024][1025]1028,1029 to 2% to 7.5% without systemic prophylaxis. 1030,1031 The majority of these infections were superficial in nature and were detected within 30 days after transplantation.…”

“…Postoperative SSIs in kidney transplant recipients are caused by gram-positive organisms, particularly Staphylococcus species (including S. aureus and S. epidermidis) and Enterococcus species, gram-negative organisms, E. coli, Enterobacter species, Klebsiella species, P. aeruginosa, and yeast with Candida species. 1004,[1014][1015][1016][1017][1018][1019][1020][1021]1023,1024,1026,1028,1030,1034 One study site in Brazil reported a high level of antimicrobial resistance. 1030 Organisms recovered from infections included MRSA (77%), methicillin-resistant coagulasenegative Staphylococcus (53.5%), extended-spectrum b-lactamaseproducing K. pneumoniae (80%), and carbapenem-resistant P. aeruginosa (33.3%).…”

“…These have included at least one randomized controlled trial 1014 and many prospective and retrospective studies comparing infection rates with prophylaxis and historical infection rates at specific transplantation centers. [1015][1016][1017][1018]1021,[1033][1034][1035] Based on the available literature, the routine use of systemic antimicrobial prophylaxis is justified in patients undergoing kidney transplantation.…”

Perioperative Antibiotikaprophylaxe bei offenen urologischen Eingriffen

“…Hieraus resultiert ein Anstieg der Inzidenz für Wundinfektionen, die ohne perioperative Antibiotikaprophylaxe zwischen 10 und 50 % schwankt [3,25,26,27,34,36,41,42,46]. Durch die konsequente perioperative antibiotische Prophylaxe konnte die Wundinfektionsrate auf unter 2 % gesenkt werden [3,26,38,46].…”