The role of preemptive antimicrobial therapy in kidney recipients of urine-only positive donor cultures.
Adult
Aged
Anti-Infective Agents
/ therapeutic use
Antibiotic Prophylaxis
Bacteria
/ drug effects
Colony Count, Microbial
Female
Fungi
/ drug effects
Humans
Infections
/ transmission
Kidney
/ microbiology
Kidney Transplantation
/ adverse effects
Male
Middle Aged
Retrospective Studies
Tissue Donors
Transplant Recipients
/ statistics & numerical data
donor-derived infections
kidney transplant
preemptive antimicrobials
Journal
Transplant infectious disease : an official journal of the Transplantation Society
ISSN: 1399-3062
Titre abrégé: Transpl Infect Dis
Pays: Denmark
ID NLM: 100883688
Informations de publication
Date de publication:
Oct 2019
Oct 2019
Historique:
received:
02
10
2018
revised:
14
06
2019
accepted:
14
07
2019
pubmed:
28
7
2019
medline:
27
2
2020
entrez:
27
7
2019
Statut:
ppublish
Résumé
The use of preemptive antimicrobial therapy for recipients of donors with microbial growth on pre-transplant urine cultures remains poorly studied. Single-center retrospective study of kidney transplant recipients of allografts from deceased donors with urine-only (ie, in absence of donor bacteremia) positive cultures (September 2011 to August 2015). Transplant outcomes, including donor-derived infections (DDI) within the first three months post transplant, were analyzed. Of the 970 kidney transplants performed during the study period, urine cultures were obtained from all donors, and of these, 27 (2.8%) yielded growth. Twenty-nine (73%) recipients were treated preemptively after transplantation. All of the recipients of donors with urine cultures positive for Enterococcus, Pseudomonas, or Candida spp. received therapy whereas only one of seven recipients with urine cultures positive for Escherichia coli was treated (P < .0001). All E coli isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), which was given to all patients for Pneumocystis pneumonia (PCP) prophylaxis. Infection within 3 months was evident in 16 (40%) patients: 10 out of 29 (35%) in the preemptive group and 6 out of 11 (55%) in the not-treatment group (P = .29). Evidence of DDI occurred in two recipients, one in each group. There were no differences in one-year graft and patient survival between groups. Preemptive antibiotic therapy did not seem to impact transmission events and transplant outcomes in this small cohort. Low transmission rates might have been influenced by administration of PCP prophylaxis and universal preemptive therapy for positive donor urine cultures with virulent organisms. Larger studies are needed.
Sections du résumé
BACKGROUND
BACKGROUND
The use of preemptive antimicrobial therapy for recipients of donors with microbial growth on pre-transplant urine cultures remains poorly studied.
METHODS
METHODS
Single-center retrospective study of kidney transplant recipients of allografts from deceased donors with urine-only (ie, in absence of donor bacteremia) positive cultures (September 2011 to August 2015). Transplant outcomes, including donor-derived infections (DDI) within the first three months post transplant, were analyzed.
RESULTS
RESULTS
Of the 970 kidney transplants performed during the study period, urine cultures were obtained from all donors, and of these, 27 (2.8%) yielded growth. Twenty-nine (73%) recipients were treated preemptively after transplantation. All of the recipients of donors with urine cultures positive for Enterococcus, Pseudomonas, or Candida spp. received therapy whereas only one of seven recipients with urine cultures positive for Escherichia coli was treated (P < .0001). All E coli isolates were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), which was given to all patients for Pneumocystis pneumonia (PCP) prophylaxis. Infection within 3 months was evident in 16 (40%) patients: 10 out of 29 (35%) in the preemptive group and 6 out of 11 (55%) in the not-treatment group (P = .29). Evidence of DDI occurred in two recipients, one in each group. There were no differences in one-year graft and patient survival between groups.
CONCLUSION
CONCLUSIONS
Preemptive antibiotic therapy did not seem to impact transmission events and transplant outcomes in this small cohort. Low transmission rates might have been influenced by administration of PCP prophylaxis and universal preemptive therapy for positive donor urine cultures with virulent organisms. Larger studies are needed.
Substances chimiques
Anti-Infective Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13150Informations de copyright
© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Références
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