Post-Operative Infectious Complications among Renal Transplant Recipients in the Multi-Drug Resistant Era: A Single Institutional Study from a High Volume Renal Transplant Center (2008-2012).

Abstract

Purpose: To analyze the impact of ESCAPE pathogens on post-operative infectious complications in a large contemporary renal transplant (RT) population. Methods: 1,012 RT recipients (2008-2012) from a single, large transplant center formed the study population. Demographic and clinical data was abstracted. Standard statistical methods were employed. Results: Post-operative infections were seen in 16.4% of RT patients (166/1,012). Resistant ESCAPE pathogens were seen in 5.4% (11) in 2008, 1.8% (4) in 2009, 4.8% (9) in 2010, 3.6% (7) in 2011 and 4.2% (9) in 2012 (p=0.31). UTI (7.2%) and surgical site infection (3.9%) were the most common infection sites followed by blood stream infection (1.5%). RT patients with early post-operative infection were 5 years older than those without infection, p=0.003. No significant gender differences was observed (p=0.112). African Americans (21.2%), deceased donor recipients (21%), those receiving thymoglobulin induction (18.5%), those with delayed graft function (16.8%), diabetes (19.3%) and leukopenia (18.6%) had higher infection rates (p<0.05 in each case). Patients with infection had shorter mean antibiotic administration to incision time (19 versus 22 minutes), p=0.041, but longer hospital stay (8 versus 5 days), p<0.001.Table: No Caption available.Conclusions: ESCAPE organisms accounted for only 3 -5% of the organisms isolated from post-operative infections in a modern large single-center RT population. African Americans, deceased donor recipients, thymoglobulin, diabetes and leukopenia were associated with increased rate of post-operative infection, and highlight a group of patients in whom rigid attention to aseptic technique, hemostasis and infection control practices maybe impactful and worthy of additional study.