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Risk factors for surgical site infection after kidney and pancreas transplantation

Published online by Cambridge University Press:  13 July 2018

Yoichiro Natori ,
Salma Albahrani ,
Mohammed Alabdulla ,
James Vu ,
Edwin Chow ,
Shahid Husain ,
Deepali Kumar ,
Atul Humar ,
Jeffrey Schiff  and
Mark Cattral
...Show all authors
Yoichiro Natori
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
Salma Albahrani
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, King Fahad Military Complex, Dahran, Saudi Arabia
Mohammed Alabdulla
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, King Saud Medical City, Saudi Arabia
James Vu
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
Edwin Chow
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
Shahid Husain
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
Deepali Kumar
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
Atul Humar
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
Jeffrey Schiff
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
Mark Cattral
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
Coleman Rotstein*
Affiliation:
Multi-Organ Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
*
Author for correspondence: Coleman Rotstein, MD, University Health Network, Toronto General Hospital, 200 Elizabeth Street, PMB 11-139, Toronto, Ontario M5G 2C4. E-mail: Coleman.Rotstein@uhn.ca
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Abstract

Objective

To evaluate the incidence of surgical site infection (SSI) in a cohort of pancreas transplant recipients and assess predisposing risk factors for SSI

Design

Retrospective cohort study

Setting

Single transplant center in Canada

Patients

Patients who underwent any simultaneous pancreas and kidney (SPK) or pancreas after kidney (PAK) transplant procedures between January 2000 and December 2015

Methods

In this retrospective cohort evaluation of SPK or PAK recipients, we assessed the incidence of SSI and risk factors associated with superficial, deep, and organ/space SSI. Multivariate logistic regression was used to identify independent risk factors for SSI in SPK and PAK recipients.

Results

In total, 445 adult transplant recipients were enrolled. The median age of these patients was 51 years (range, 19–71 years), and 64.9% were men. SSIs were documented in 108 patients (24.3%). Organ/space SSIs predominated (59 patients, 54.6%), followed by superficial SSIs (47 patients, 43.5%) and deep SSIs (3 patients, 2.8%). Factors predictive of SSIs in the multivariate analysis were cold pancreas ischemic time (odds ratio [OR], 1.002; P=.019) and SPK transplant (compared to PAK transplant recipients; OR, 2.38; P=.038). Patients with SSIs developed graft loss more frequently (OR, 16.99; P<.001).

Conclusions

Organ/space SSIs remain a serious and common complication after SPK and PAK. Prolonged cold ischemic time and SPK transplant were the risk factors predictive of SSIs. Appropriate perioperative prophylaxis in high-risk patients targeting the potential pathogens producing SSIs in kidney and/or pancreas transplant recipients and a reduction in cold ischemia may prove beneficial in reducing these SSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1042 - 1048
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Natori Y, et al. (2018). Risk factors for surgical site infection after kidney and pancreas transplantation. Infection Control & Hospital Epidemiology 2018, 39, 1042–1048. doi:10.1017/ice.2018.148

PREVIOUS PRESENTATION. These results were presented in part at ID Week 2017 in San Diego, California, on October 4–8, 2017 (abstract #2218).

References

1. Knight, RJ, Lawless, A, Patel, SJ, Gaber, AO. Simultaneous kidney-pancreas transplantation for end-stage renal disease patients with insulin-dependent diabetes and detectable C-peptide. Transpl Proc 2010;42:4195–4196.Google Scholar
2. Freise, CE, Narumi, S, Stock, PG, Melzer, JS. Simultaneous pancreas-kidney transplantation: an overview of indications, complications, and outcomes. West J Med 1999;170:11–18.Google Scholar
3. Dharnidharka, VR, Stablein, DM, Harmon, WE. Post-transplant infections now exceed acute rejection as cause for hospitalization: a report of the NAPRTCS. Am J Transpl 2004;4:384–389.Google Scholar
4. Anesi, JA, Blumberg, EA, Abbo, LM. Perioperative antibiotic prophylaxis to prevent surgical site infections in solid organ transplantation. Transplantation 2018;102:21–34.Google Scholar
5. Everett, JE, Wahoff, DC, Statz, C, et al. Characterization and impact of wound infection after pancreas transplantation. Arch Surg 1994;129:1310–1316; discussion, 1316–1317.Google Scholar
6. Baktavatsalam, R, Little, DM, Connolly, EM, Farrell, JG, Hickey, DP. Complications relating to the urinary tract associated with bladder-drained pancreatic transplantation. Br J Urol 1998;81:219–223.Google Scholar
7. Pirsch, JD, Odorico, JS, D’Alessandro, AM, Knechtle, SJ, Becker, BN, Sollinger, HW. Posttransplant infection in enteric versus bladder-drained simultaneous pancreas-kidney transplant recipients. Transplantation 1998;66:1746–1750.Google Scholar
8. Woeste, G, Wullstein, C, Vogt, J, Zapletal, C, Bechstein, WO. Value of donor swabs for intra-abdominal infection in simultaneous pancreas-kidney transplantation. Transplantation 2003;76:1073–1078.Google Scholar
9. Perdiz, LB, Furtado, GH, Linhares, MM, Gonzalez, AM, Pestana, JO, Medeiros, EA. Incidence and risk factors for surgical site infection after simultaneous pancreas-kidney transplantation. J Hosp Infect 2009;72:326–331.Google Scholar
10. Patel, G, Snydman, DR, AST Infectious Diseases Community of Practice. Vancomycin-resistant Enterococcus infections in solid organ transplantation. Am J Transpl 2013;13(Suppl 4):59–67.Google Scholar
11. Cattral, MS, Bigam, DL, Hemming, AW, et al. Portal venous and enteric exocrine drainage versus systemic venous and bladder exocrine drainage of pancreas grafts: clinical outcome of 40 consecutive transplant recipients. Ann Surg 2000;232:688–695.Google Scholar
12. Surgical site infection(SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscmanual/9pscssicurrent.pdf. Published 2016. Accessed November 24, 2016.Google Scholar
13. Bassetti, M, Salvalaggio, PR, Topal, J, et al. Incidence, timing and site of infections among pancreas transplant recipients. J Hosp Infect 2004;56:184–190.Google Scholar
14. Berger, N, Guggenbichler, S, Steurer, W, et al. Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants. BMC Infect Dis 2006;6:127.Google Scholar
15. Berger, N, Wirmsberger, R, Kafka, R, et al. Infectious complications following 72 consecutive enteric-drained pancreas transplants. Transpl Int 2006;19:549–557.Google Scholar
16. Fontana, I, Bertocchi, M, Diviacco, P, et al. Infections after simultaneous pancreas and kidney transplantation: a single-center experience. Transpl Proc 2009;41:1333–1335.Google Scholar
17. Linhares, MM, Gonzalez, AM, Triviño, T, et al. Simultaneous pancreas-kidney transplantation: infectious complications and microbiological aspects. Transpl Proc 2004;36:980–981.Google Scholar
18. Martins, L, Pedroso, S, Henriques, AC, et al. Simultaneous pancreas-kidney transplantation: five-year results from a single center. Transpl Proc 2006;38:1929–1932.Google Scholar
19. Michalak, G, Kwiatkowski, A, Bieniasz, M, et al. Infectious complications after simultaneous pancreas-kidney transplantation. Transpl Proc 2005;37:3560–3563.Google Scholar
20. Steurer, W, Tabbi, MG, Bonatti, H, et al. Stapler duodenojejunostomy reduces intraabdominal infection after combined pancreas kidney transplantation as compared with hand-sawn anastomosis. Transpl Proc 2002;34:3357–3360.Google Scholar
21. Ziaja, J, Krol, R, Chudek, J, et al. Intra-abdominal infections after simultaneous pancreas – kidney transplantation. Ann Transpl 2011;16:36–43.Google Scholar
22. Kim, RD, Oreopoulos, DG, Qiu, K, et al. Impact of mode of dialysis on intra-abdominal infection after simultaneous pancreas-kidney transplantation. Transplantation 2005;80:339–343.Google Scholar