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Choi, Oh, Kim, Shin, Kim, Kim, and Sun: Routine Perioperative Antibiotic Prophylaxis in Renal Transplantation: It Makes No Difference for Bacterial Infections
Original Article

J Korean Soc Transplant 2010;24(1):13-18.

Published online: 10 March 2010

DOI: https://doi.org/10.4285/jkstn.2010.24.1.13

Routine Perioperative Antibiotic Prophylaxis in Renal Transplantation: It Makes No Difference for Bacterial Infections

Seong-Uk Choi, M.D.1, Chang-Kwon Oh, M.D.1, Ji-Hye Kim, R.N.1, Gyu-Tae Shin, M.D.2, Heungsoo Kim, M.D.2, Se-Jung Kim, M.D.3, Il Kim Sun, M.D.3

1Departments of Surgery, Division of transplantation, Ajou University School of Medicine, Suwon, Korea

2Nephrology, Ajou University School of Medicine, Suwon, Korea

3Urology, Ajou University School of Medicine, Suwon, Korea

책임저자：오창권, 경기도 수원시 영통구 원천동 산 5아주대학교 의과대학 외과학교실, 443-721 Tel: 031-219-5199, Fax: 031-219-5755 E-mail: ohck@ajou.ac.kr

Copyright © 2010 The Korean Society for Transplantation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Although it has been a popular practice to use preventative antibiotics for the kidney recipients, it could increase the cost, encourage the growth of resistant micro-organism and have adverse effects. There has been no reported concrete evidence about the benefits and risks of using perioperative prophylactic antibiotics for an immunosuppressed population. Therefore, we retrospectively evaluated the differences in the incidences of bacterial infection and adverse events after transplant surgery according to using perioperative prophylactic antibiotics.

Methods

We reviewed retrospectively 106 cases of renal transplantations (cadaver donor: 42 cases, living donor: 64 cases) that were performed at Ajou University Hospital, Korea from January, 2006 to December, 2008. We divided the cases into two groups: Group A (n=41; 38.7%) included the patients who did not receive prophylactic antibiotics and Group B (n= 65; 61.3%) included the patients who did receive prophylactic antibiotics. We analyzed the infectious complications that occurred within 1 month after renal transplantation.

Results

In Group A, most patients (62 cases, 95.3%) used a 1 st generation cephalosporin. The incidence of wound infection after kidney transplant for the 65 patients who received prophylactic antibiotics was 1.5%, compared to 2.5% for the 41 patients who did not receive prophylactic antibiotics.

Conclusions

This retrospective study could not demonstrate a statistically significant difference in the rates of infectious complications between the two groups, although renal transplantation is considered to be a clean-contaminated surgery. But in order to obtain a definite conclusion, we need a bigger cohort in a prospective study.

Keywords: Kidney transplantation, Infection, Antibiotic prophylaxis

References

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Table 1.
Demographic characteristics of renal transplant recipients (n=106)
  No PAP (n=41) PAP (n=65) P
Gender      
Male (n=66) 22 (33.3%)/66 44 (66.7%)/66  
Female (n=40) 19 (47.5%)/40 21 (52.5%)/40 0.147
Recipient age (yrs) 39.9±11.1 42.8±10.5 0.459
Donor type      
Living donor 23 (35.9%)/64 41 (64.1%)/64  
Cadaver donor 18 (42.9%)/42 24 (57.1%)/42 0.474
ESRD duration (months) 31.3±31.3 32.2±38.8 0.906
Mode of dialysis      
HD 23 (33.8%)/68 45 (66.2%)/68  
PD 12 (50.0%)/24 12 (50.0%)/24  
None 6 (42.9%)/14 8 (57.1%)/14 0.354
Diabetes 5 (27.8%)/18 13 (72.2%)/18 0.427
VUR      
VUR (＋) 8 (42.1%)/19 11 (57.9%)/19  
VUR (−) 23 (37.7%)/61 38 (62.3%)/61  
Undetermined 10 (38.5%)/26 16 (61.5%)/26 0.942
BMI(kg/m2)      
＜20 13 (43.3%)/30 17 (56.7%)/30  
＜20∼25 21 (32.3%)/65 44 (67.7%)/65  
＞25 7 (63.6%)/11 4 (36.4%)/11 0.118
Cyclosporine based 16 (20.8%)/77 61 (79.2%)/77  
＋ MMF＋ steroid 16 54  
＋ sirolimus＋ steroid 0 5  
＋ steroid0 2    
Tacrolimus based 25 (86.2%)/29 4 (13.8%)/29 0.000
＋ MMF＋ steroid 23 4  
＋ sirolimus＋ steroid 0 0  
＋ steroid 2 0  

Abbreviations: PAP, perioperative antibiotic prophylaxis; ESRD, end stage renal disease; HD, hemodialysis; PD, peritoneal dialysis; VUR, vesico-ureteral reflux; BMI, body mass index; MMF, mycophenolate mofetil.

Table 2.
Sites of infection after kidney transplantation (n= 106)
Sites No PAP PAP Percent (%) P
Wound 1 1 1.8 1.000
Urinary tract 0 2 1.8 0.521
Bacteremia 0 3 2.8 0.282
Infection of surgical 0 1 0.9 1.000
site fluid collection        
Surgical drain catheter 0 2 1.8 0.521
Total 1 9 9.4  
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