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Correlation of intraoperative donor duodenal-segment swab cultures with the subsequent occurrence of surgical site infections in kidney and pancreas transplant recipients
Published online by Cambridge University Press: 23 June 2020
Abstract
Background:
Pancreas transplantation is employed for the treatment of type I diabetes mellitus. It is postulated that surgical site infection (SSI), particularly organ-space infections, after pancreas transplantation may arise from microbial contamination arising from the donor duodenal segment. Therefore, some centers have adopted the practice of culturing the donor duodenal segment and subsequently administering antimicrobial therapy to the recipient directed at the microorganisms isolated to prevent SSI.
Methods:
In this retrospective cohort study, we evaluated the correlation between positive donor duodenal-segment cultures and SSIs in the recipients. Data were recorded and analyzed to assess the correlation of the organisms isolated in the donor duodenal cultures with those producing SSI in the recipients.
Results:
We evaluated 379 consecutive pancreas transplant recipients from January 2000 to December 2015. Donor duodenal swab cultures were performed at the time of pancreas transplantation, and 206 (54.3%) were positive. SSIs occurred in 51 of the 206 recipients (24.8%) with positive duodenal-segment cultures and in 41 of 173 individuals (23.7%) with negative cultures (P = .81; r = 0.00). Notably, deep and organ-space SSIs were observed in 27 of 206 of the positive duodenal culture groups (13.1%) versus 29 of 173 of the negative duodenal culture groups (16.8%; P = 0.31; r = −0.059). No differences were detected in the pathogens producing SSIs between the group with a positive duodenal swab versus the group with a negative swab. Microorganisms producing SSIs matched those found in the positive donor duodenal cultures in only 15 patients (7.8%).
Conclusion:
Although positive cultures from the donor duodenal segment prompted the administration of antimicrobial therapy in the recipient directed against the pathogen isolated, this practice did not reduce SSIs compared with those transplant recipients with culture-negative duodenal swabs. In addition, the organisms isolated from the donor duodenal segment were not predictive of subsequent SSI.
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- © 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
References
Perdiz, LB, Furtado, GHC, Linhares, MM, Gonzalez, AM, Pestana, JOM, Medeiros, EAS. Incidence and risk factors for surgical site infection after simultaneous pancreas–kidney transplantation. J Hospital Infect 2009;72:326–331.10.1016/j.jhin.2009.04.016CrossRefGoogle ScholarPubMed
Michalak, G, Kwiatkowski, A, Bieniasz, M, et al.Infectious complications after simultaneous pancreas–kidney transplantation. Transplant Proc 2005;37:3560–3563.CrossRefGoogle ScholarPubMed
Smets, YF, Van der Pijl, JW, Van Dissel, JT, Ringers, J, De Fijter, JW, Lemkes, HH. Infectious disease complications of simultaneous pancreas kidney transplantation. Nephro Dial Transpl 1997;12:764–771.CrossRefGoogle ScholarPubMed
Natori, Y, Albahrani, S, Alabdulla, M, et al.Risk factors for surgical site infections after kidney and pancreas transplantation. Infect Control Hosp Epidemiol 2018;39:1042–1048.10.1017/ice.2018.148CrossRefGoogle ScholarPubMed
Anesi, JA, Blumberg, EA, Abbo, LM. Perioperative antibiotic prophylaxis to prevent surgical site infections in solid organ transplantation. Transplantation 2018;102:21–34.10.1097/TP.0000000000001848CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Gruessner, AC, Gruessner, RWG. Kidney Transplantation: Principles and Practice, 7th ed. London: Elsevier Health Sciences, 2013; pp. 584–605.Google Scholar
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.CrossRefGoogle ScholarPubMed
Berríos-Torres, SI, Umscheid, CA, Bratzler, DW, et al.Centers for disease control and prevention guideline for the prevention of surgical site infection. JAMA Surg 2017;152:784–791.CrossRefGoogle ScholarPubMed
Haridas, M, Malangoni, MA. Predictive factors for surgical site infection in general surgery. Surgery 2008;144:496–503.10.1016/j.surg.2008.06.001CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Surgical site infection (SSI) event. Centers for Disease Control and Prevention website. http://www.cdc.gov/nhsn/PDFs/pscmanual/9pscssicurrent.pdf. Published 2016. Accessed August 17, 2019.Google Scholar
Humar, A, Kandaswamy, R, Granger, D, et al.Decreased surgical risks of pancreas transplantation in the modern era. Ann Surg 2000;231:269–275.CrossRefGoogle ScholarPubMed
Troppmann, C, Gruessner, AC, Benedetti, E, et al.Positive duodenal segment cultures are not associated with increased surgical complications after whole organ, bladder-drained pancreas transplantation in three categories. Transplant Proc 1995;27:3101–3103.Google ScholarPubMed
Alabdulla et al. supplementary material
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