Infectious disease complications of simultaneous pancreas kidney transplantation
| Autor: | J. T. Van Dissel, Herman H.P.J. Lemkes, J.W. van der Pijl, Y. F. C. Smets, Jan Ringers, J.W. de Fijter |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Opportunistic infection medicine.medical_treatment Foley catheter Bacteremia Pancreas transplantation Communicable Diseases medicine Humans Surgical Wound Infection Diabetic Nephropathies Antibiotic prophylaxis Kidney transplantation Retrospective Studies Transplantation business.industry Graft Survival Middle Aged medicine.disease Kidney Transplantation Anti-Bacterial Agents Surgery Diabetes Mellitus Type 1 Mycoses Virus Diseases Nephrology Urinary Tract Infections Kidney Failure Chronic Drug Therapy Combination Female Pancreas Transplantation business Kidney disease |
| Zdroj: | Nephrology Dialysis Transplantation. 12:764-771 |
| ISSN: | 1460-2385 0931-0509 |
| Popis: | Background. Although technical success rate of simultaneous pancreas kidney (SPK) transplantation in insulin-dependent diabetes mellitus (IDDM) patients with diabetic nephropathy has improved, morbidity remains high due to infection and rejection. The purpose of this study was to analyse infections encountered in our series of SPK transplants, using a restrictive antibiotic prophylaxis policy. Methods. We reviewed all infectious diseases after 66 consecutive bladder-drained SPK transplantations in 64 IDDM patients with end-stage renal disease due to diabetic nephropathy. During follow-up, the perioperative antibiotic regimen was altered (from 5 days pre-emptive therapy with multiple drugs to 1 day prophylaxis with cefamandole), and long-term viral prophylaxis (high-dose aciclovir) was introduced. For post-operative urinary tract or opportunistic infection, no prophylaxis was given. Results. Overall mean infection rate was 2.9 infections/ patient/year after a mean follow-up of 2.3 years. Surgical site infections (SSI) were seen in 30% of the patients, with Enterococci present in 47%. Logistic regression showed one day cefamandole prophylaxis to be associated with SSI, but there was no significant influence of SSI on either graft or patient survival. Forty-eight percent of all infections were lower urinary tract infections (UTI). There were 59 first UTIs (89%), probably related to long-term Foley catheter use, and 47 second UTIs (71%). Subsequent UTIs were not microbiologically related to first UTIs. Cytomegalovirus (10 patients) and other opportunistic agents did not cause mortality or graft loss. Five grafts were lost due to infection (SSI three times, post-transplant lymphoproliferative disease twice). Only one patient died because of infection (2%). Conclusions. Infectious diseases after SPK transplantation caused significant morbidity but did not influence either patient or graft survival. A change in prophylactic policy for both SSI as well as recurrent UTI, combined with earlier Foley removal, may lower incid-ences of these infections. |
| Databáze: | OpenAIRE |
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