Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study.

Autor:	Corbel A; Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France. Electronic address: a.corbel@chru-nancy.fr., Ladrière M; Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France., Le Berre N; Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France., Durin L; Agence de la Biomédecine, Saint Denis La Plaine, France., Rousseau H; Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France., Frimat L; Nephrology Dialysis Transplantation Department, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France., Thilly N; Plateforme d'Aide à la Recherche Clinique, University of Lorraine, CHRU-Nancy, Nancy, France; APEMAC, University of Lorraine, Nancy, France., Pulcini C; APEMAC, University of Lorraine, Nancy, France; Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, Nancy, France.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2020 Apr; Vol. 26 (4), pp. 475-484. Date of Electronic Publication: 2019 Aug 02.
DOI:	10.1016/j.cmi.2019.07.018
Abstrakt:	Objectives: Kidney transplant recipients are at high-risk for donor-derived infections in the early post-transplant period. Transplant preservation fluid (PF) samples are collected for microbiological analysis. In case of positive PF cultures, the risk for the recipient is unknown and there is no consensus for prescribing prophylactic antibiotics. This nationwide observational study aimed to determine the epidemiology of bacterial and fungal agents in kidney transplant PF cultures and identify risk factors associated with positive PF cultures. Methods: We performed a retrospective observational study on the following data collected from a national database between October 2015 and December 2016: characteristics of donor, recipient, transplantation, infection in donor and PF microbiological data. Results: Of 4487 kidney transplant procedures, including 725 (16.2%, 725/4487) from living donors, 20.5% had positive PF cultures (living donors: 1.8%, 13/725; deceased donors: 24.1%, 907/3762). Polymicrobial contamination was found in 59.9% (485/810) of positive PF cultures. Coagulase-negative staphylococci (65.8%, 533/810) and Enterobacteriaceae (28.0%, 227/810) were the most common microorganisms. Factors associated with an increased risk of positive PF cultures in multivariable analysis were (for deceased-donor kidney transplants): intestinal perforation during procurement (OR 4.4, 95% CI 2.1-9.1), multiorgan procurement (OR 1.4, 95% CI 1.1-1.7) and en bloc transplantation (OR 2.5, 95% CI 1.3-4.9). Use of perfusion pump and donor antibiotic therapy were associated with a lower risk of positive PF cultures (OR 0.4, 95% CI 0.3-0.5 and OR 0.6, 95% CI 0.5-0.7, respectively). Conclusion: In conclusion, 24% of deceased-donor PF cultures were positive, and PF contamination during procurement seemed to be the major cause. (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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