Nephrology Dialysis Transplantation, Vol 13, Issue 7 1637-1641, Copyright © 1998 by Oxford University Press
K Midtvedt, A Hartman, T Midtvedt and I Brekke
Background: Perioperative antibiotic prophylaxis may
prevent infection following renal transplantation but it also contributes
to development of resistant microorganisms. With refined surgical
techniques, improved graft preservation, and immunosuppressive monitoring
during recent decades one can question the present use of perioperative
antibiotic prophylaxis. We retrospectively evaluated the incidence of
infection in our renal transplant centre where antibiotic prophylaxis is
not routinely used in renal recipients. Concurrently we performed a survey
of perioperative antibiotic use to establish the current world-wide
practice. Methods: Infection episodes were evaluated
from records of 448 adult renal transplant recipients (January 1994 to
August 1996) at our centre. A questionnaire was mailed to 103 centres
addressing the number of kidney transplantations in 1995, donor source
(living vs cadaveric) and details on use of
perioperative antibiotic prophylaxis. Results:
Single-centre study. Renal transplantation was
performed without antibiotic prophylaxis in 377 patients (84%). Thirteen
patients (3.4%) had early postoperative infections, nine with urinary-tract
infection tended to have urinary catheter for a longer period than those
without infection (5.0±2.7 vs
3.4±1.4 days, P-0.27) and cadaveric kidney recipients to have
higher incidence of infections (4.5 vs 1.5% P=0.14).
All infection episodes were successfully treated. The infection incidence
in 71 (16%) 'high-risk' patients selected for antibiotic treatment was
4.2%. World-wide survey. Data were obtained from 101
centres in five continents representing 10 532 renal transplants. Ninety
centres (89%) used perioperative antibiotic prophylaxis.
Conclusion: The infection incidence in patients who
did not receive perioperative antibiotic prophylaxis was the same as in a
small group of selected patients who received prophylaxis. The incidence
was lower than usually reported in the literature. In contrast
perioperative antibiotic prophylaxis is given to all patients in almost 90%
of transplant centres world-wide. A reduction of prophylactic antibiotic
use is encouraged. Key words: early post-transplant
infection incidence; perioperative antibiotic prophylaxis; world wide
survey
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Routine perioperative antibiotic prophylaxis in renal transplantation
Departments of Internal Medicine and Surgery, The National Hospital, University of Oslo, Norway; Laboratory of Medical Microbial Ecology, Karolinska Institutet, Stockholm, Sweden; Corresponding author at: Medical Department B III, Rikshospitalet, N-0027 Oslo, Norway
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