title: The role of antibiotic prophylaxis in the new era of immunosuppression.
abstract: Despite significant improvements in renal transplantation (RTX), certain basic issues remain unresolved such as the routine use of perioperative antibiotic prophylaxis (PAP). To address the need for PAP, we retrospectively evaluated the clinical course of 349 consecutive RTX patients who did not receive any PAP except for Bactrim. Of the 349 transplant recipients, 77% received induction therapy with low-dose rabbit antithymocyte globulin (rATG) and the others were treated with basiliximab. All patients received triple immunosuppression with tacrolimus, mycophenolic acid, and prednisone. Seven patients (2%) developed wound infections. Wound infections were more common in obese and older patients. All wound infections were superficial and responded well to wound drainage and outpatient antibiotic therapy. Six patients (1.7%) experienced a urinary tract infection (UTI) within the first postoperative month. UTIs were more common in the patient with ureteral stent compared to nonstented patients (11.4% vs 0.3%, P<.001). No patient or graft was lost due to perioperative bacterial infections (PBI). Our study shows that despite many predisposing factors, PBI are rare following RTX even in the absence of PAP. Therefore, in order to avoid emergence of multiantibiotic-resistant pathogens, excessive costs, and antibiotic-related adverse events, we suggest that PAP should be used only in selected circumstances such as in recipients older than 60 or when the body mass index is greater than 35.
authors: Department of Surgery, SUNY at Buffalo, Buffalo General Hospital, Buffalo, New York 14203, USA. mlaftavi@kaleidahealth.org
authors: M R
authors: MR
authors: Laftavi
authors: R
authors: R
authors: Rostami
authors: L
authors: L
authors: Feng
authors: M
authors: M
authors: Said
authors: R
authors: R
authors: Kohli
authors: M
authors: M
authors: Dayton
authors: O
authors: O
authors: Pankewycz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D000911:Antibodies, Monoclonal / Q000494:pharmacology; D000961:Antilymphocyte Serum / Q000378:metabolism*; D001424:Bacterial Infections / Q000517:prevention & control; D000077552:Basiliximab; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000494:pharmacology; D011241:Prednisone / Q000494:pharmacology; D011817:Rabbits; D011993:Recombinant Fusion Proteins / Q000494:pharmacology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000494:pharmacology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology; D014552:Urinary Tract Infections / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D000077552:Basiliximab; D009173:Mycophenolic Acid; D011241:Prednisone; D016559:Tacrolimus