Antimicrobial Prophylaxis in Kidney Transplant Donors “Lesser the Better”

Introduction: Preoperative antimicrobial prophylaxis is crucial for reducing surgical site infections (SSIs) in kidney transplant donors. Purpose of the study was to compare the effects of various doses of antimicrobial prophylaxis in patients undergoing kidney transplants to reduce the incidence of SSIs.Methods: This retrospective cohort study was confined to ۶۳۲ living kidney donors at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC), Lahore, Pakistan between May ۲۰۱۸ and April ۲۰۲۴. Consequently, the study incorporated donors who underwent antimicrobial prophylaxis within the period of surgery management. Patient-level data were identified from electronic medical record (EMR) such as age, gender, comorbid conditions, preoperative detail, antimicrobial prophylactic information, and postoperative results. The sample source was therefore the patients who underwent surgery in the participating health facilities and the main outcome for analysis was the number of SSIs that occurred within ۳۰ days of the operation. Descriptive statistics, including median values expressed with interquartile ranges (IQR), chi-square tests of independence, and Fisher's exact logistic regression tests were used to compare SSIs with specific prophylaxis regimens.Results: Among the ۶۳۲ donors, ۳۶۲ (۵۷.۳%) were female and ۲۷۰ (۴۲.۷%) were male. The median age was ۳۵ years (IQR ۳۰–۴۲ years). ۵۳۰ donors (۸۳.۹%) received a single preoperative antibiotic dose. The incidence of superficial SSIs was in ۹ (۱.۴%) donors. Donors receiving multiple doses of antibiotics preoperatively had a higher likelihood of developing SSIs compared to those receiving a single dose (OR: ۲۰.۸۴, P-Value=۰.۰۰۱). Conversely, ۶۲۵ donors positive for cytomegalovirus (CMV) (۹۸.۹%) were less likely to develop SSIs (OR: ۰.۰۷, P-Value=۰.۰۲۹).Conclusion: Minimizing preoperative antibiotic doses may reduce the risk of SSIs in kidney transplant donors. The study supports a "lesser is better" approach to antimicrobial prophylaxis, highlighting the need for further research on CMV's potential protective effect against SSIs.

کلیدواژه ها:

Antimicrobial prophylaxis ، Kidney transplant donors ، Surgical site infections (SSIs) ، Postoperative complications