Surgical site infections after kidney transplantation--where do we stand now?

Background: Kidney transplantation (KTx) is a widely accepted method of renal function replacement therapy. Surgical site infections (SSIs), along with urinary tract infections, are among the most common infective complications after KTx. The purpose of this study was to assess the incidence of SSI in patients after KTx, identify risk factors for SSI, and classify patients in which standard antibiotic prophylaxis could be avoided.

Methods: Between January 2010 and December 2011, 262 KTxs were performed in our center. Deceased donors', recipients' data, and data related to surgical procedures were collected. SSIs were diagnosed in accordance with the guidelines published by the U.S. Centers for Disease Control and Prevention.

Results: SSIs were diagnosed in 7.25% (19/262) of patients. Of nineteen SSI patients, two (10.5%) were diagnosed with organ-specific SSIs, which eventually led to graft loss; six (31.5%) developed deep incisional SSIs; and eleven (58%) developed superficial incisional SSIs. Through analysis of this extensive data set, we determined the following risk factors for the development of SSI: kidney from extended criteria donors, a cold ischemia time of more than 30 hr, time of surgical procedure longer than 200 min, confirmed diabetes in the recipients, a recipient body mass index higher than 27 kg/m, and occurrence of delayed graft function.

Conclusions: It may be possible to reduce standard antibiotic prophylaxis to a single dose in patients without known risk factors for SSI. Any opportunity to reduce antibiotic use is crucial in preventing the development of multi-drug-resistant pathogens.