title: Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation.
abstract: BACKGROUND
  Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs.
  
  
  METHODS
  We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation.
  
  
  RESULTS
  A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function.
  
  
  CONCLUSIONS
  Amikacin prophylaxis is a useful strategy for preventing SSIs.
authors.affiliation: 1 Hospital Epidemiology and Infection Control Team, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 2 Renal Transplantation Service, Department of Urology, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil. 3 Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Maristela P
authors.initials: MP
authors.lastname: Freire
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Antonopoulos
authors.forename: Affonso Celso
authors.initials: AC
authors.lastname: Piovesan
authors.forename: Maria L
authors.initials: ML
authors.lastname: Moura
authors.forename: Flávio Jota
authors.initials: FJ
authors.lastname: de Paula
authors.forename: Fernanda
authors.initials: F
authors.lastname: Spadão
authors.forename: Thais
authors.initials: T
authors.lastname: Guimarães
authors.forename: Elias
authors.initials: E
authors.lastname: David-Neto
authors.forename: William C
authors.initials: WC
authors.lastname: Nahas
authors.forename: Ligia C
authors.initials: LC
authors.lastname: Pierrotti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D000961:Antilymphocyte Serum / Q000737:chemistry; D002511:Cephalosporins / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D051799:Delayed Graft Function / Q000209:etiology; D004756:Enterobacteriaceae Infections / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D051437:Renal Insufficiency / Q000601:surgery*; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D000961:Antilymphocyte Serum; D002511:Cephalosporins; D000583:Amikacin; D001618:beta-Lactamases