title: Surgical site and early urinary tract infections in 1000 kidney transplants with antimicrobial perioperative prophylaxis.
abstract: Surgical site infections (SSIs) and early urinary tract infections (UTIs) are well recognized postoperative kidney transplant complications. These complications seldom lead to graft loss, although they may result in significant morbidity with prolonged hospitalization. Thus, perioperative antibiotic prophylaxis (PAP) has traditionally been used in this setting. Between April 1988 and December 2012, we identified 1000 kidney transplant recipients (33 from living donors) who underwent prophylaxis with ceftriaxone before the surgical procedure. A retrospective analysis was conducted to evaluate both the incidence rate and outcome of SSIs and UTIs. Recipients who developed SSIs were also assessed to identify risk factors and potential correlations with different immunosuppressive regimens. A total of 20 SSIs (2%) and 93 UTIs (9.3%) were observed. The most significant risk factor for SSIs was urine leak (15.38%; odds ratio [OR], 12.3; P < .0001) followed by sirolimus-based maintenance immunosuppression therapy (5%; OR, 2.97; P = .04) and induction therapy with either antithymocyte globulin or basiliximab (3.18%; OR, 3.45; P = .01). Sex was identified as the only risk factor for UTI (female vs male, 17.1% vs 4.6%; P < .0001). We believe universal ceftriaxone-based prophylaxis is useful for preventing SSIs and UTIs, considering its effectiveness and safety profile.
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Capocasale
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: E
authors.initials: E
authors.lastname: De Vecchi
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Mazzoni
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Dalla Valle
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pellegrino
authors.affiliation: Division of Urology, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Ferretti
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Sianesi
authors.affiliation: Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy. Electronic address: miaria@ao.pr.it.
authors.forename: M
authors.initials: M
authors.lastname: Iaria
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002648:Child; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents