Surgical Site Infections in Solid Organ Transplant Recipients

Abstract

Surgical site infections (SSIs) are defined as superficial infections, deep incisional infections, and organ/organ space infections that occur within 30 days of the surgical procedure or up to 90 days if a prosthetic implant has been used. Incidence of SSI is highest in recipients of small bowel transplant, followed by liver, pancreas, and kidney transplant. These are diagnosed by the presence of at least one of the following: purulent discharge from the wound, organism identified from the specimen obtained from the site with culture/nonculture-based methods, evidence of infection on gross/histopathological examination or on imaging, or a clinical diagnosis of SSI by a physician. The spectrum of organisms implicated in SSIs in solid organ transplant recipients is more diverse due to underlying end-stage organ failure, need for immunosuppression, prolonged hospitalization, colonization or active infection in the deceased organ donor, contamination during organ transportation/preservation. SSI in solid organ transplant can be prevented leading to hospital stay and cost of transplantation. Minimizing surgical operative time, sterile and appropriate surgical technique and antimicrobial prophylaxis, management of patient comorbidities as well as glucose and temperature regulation are important for prevention of SSI. This article discusses useful preventive strategies for preventing SSI such as preoperative bathing, use of appropriate preoperative antibiotic prophylaxis, surgical site and hand preparation, use of wound protectors, drapes and gowns, incisional wound irrigation, adequate nutritional support, and use of perioperative oxygenation.