Incidence of hospital-acquired infections following kidney, pancreas or kidney-pancreas transplantations: A surveillance-based study

Abstract

Background Bacterial hospital-acquired infections (HAI) are frequent complications of the early post-transplantation period. The most frequent infections are urinary tract infection, bacteremia and surgical site infection. The objective was to report the incidence of early HAI among kidney, pancreas or kidney-pancreas transplant recipients in a French university hospital. Methods An active standardized surveillance of HAI among kidney, pancreas or kidney-pancreas recipients was done in a university hospital of 800 beds (Lyon, France). All patients transplanted between October 1, 2013 and December 31, 2016 were followed during their hospital stay or up to 30 days post-transplantation. Data on patient characteristics, invasive devices, transplantation type, outcome in the unit and HAI were recorded. HAI included urinary tract infections, bacteremia, surgical site infections and pneumonia. Only the first infection per site and per patient was analyzed. Incidence rates were expressed per 1000 patient-days with their 95% confidence interval (95% CI). Multivariate Poisson regressions adjusted on gender, age, ASA score, transplantation type and time period were fitted to assess the risk of HAI. Results Overall, 568 transplanted patients accounting for 8800 patients-days were analyzed (489 kidney, 12 pancreas and 67 kidney-pancreas transplantation). Mean age was 51 years (range 19–80 y), 61% were men, mean BMI was 25 (range 15–38). Seven patients deceased (1%, none because of infection) and 50 undergone a revised surgery (4 for infectious complications); 17 grafts were removed (1 for infection). Mean length of stay, length of urinary catheterization and central venous catheterization were respectively 18 days (+14), 8 days (+6), and 10 days (+8). Donor type was living-related donor, unrelated living donor, brain death donor and cardiac arrest donor for respectively 10%, 3%, 77% and 59% of transplanted patients. Concerning deceased donor, preservation solution was contaminated for 39% of cases, with negative coagulase Staphylococcus identified in 59% of them. HAI incidence was 10.2 (95% CI: 7.2–11.3; N = 80) per 1000 patient-days, without difference according to the transplantation type (adjusted incidence rate ratio [aIRR] = 1.37; 95% CI: 0.71–2.65) in kidney vs. kidney-pancreas or pancreas recipients or time period (aIRR = 0.90; 95% CI: 0.80–1.02, per 1 semester). The 3 most frequent causative microorganisms were Escherichia coli (29%), Enterococcus faecalis (16%) and Enterobacter cloacae (13%). Enterobacteriaceae were found in 53% of HAI and 57% of them were resistant to third generation cephalosporin. Incidences of urinary tract infections, bacteremia and pneumonia were respectively 6.0 (95% CI: 4.6–7.8; N = 58), 2.4 (95% CI: 1.5–3.5; N = 23) and 0.7 (95% CI: 0.3–1.4; N = 7), without differences according to transplantation type after multivariate analysis. Surgical site infections concerned 3% of patients (incidence: 1.7; 95% CI: 1.0–2.7; N = 16) with higher incidence in kidney-pancreas or pancreas compared with kidney recipients (aIRR = 14.20; 95% CI: 3.31–60.85). Conclusion Fourteen percent of kidney and/or pancreas transplanted patients had developed at least one HAI during post-transplantation hospitalization. The most frequent type of HAI was urinary tract infection and the most frequent microorganism involved was Escherichia coli. Incidence rates varied according to infection site and according to transplantation type for SSI. Detailed description of HAI among those patients will help for preventive measures including antibiotic prophylaxis.