Universal perioperative antimicrobial prophylaxis is not necessary in kidney transplantation

Despite significant improvements in renal transplantation, certain basic issues remain unresolved such as the routine use of perioperative antimicrobial prophylaxis (AMP). To address the need for AMP, we retrospectively evaluated the clinical course of 442 consecutive renal transplant recipients (RTRs) who did not receive any AMP except for trimethoprim/sulfamethoxazole. Three hundred and forty RTRs received induction therapy with low-dose rabbit anti-thymocyte globulin, while the other 102 patients were treated with basiliximab. All RTRs received tacrolimus, mycophenolic acid, and prednisone. Nine patients (2%) developed surgical site infection (SSI). SSIs were more common in obese and older patients. All SSIs were superficial and responded well to wound drainage and outpatient antibiotic therapy. No patient or graft was lost owing to SSI. Our study shows that despite many predisposing factors, SSIs are rare following renal transplantation even in the absence of AMP. Therefore, to avoid the emergence of antibiotic-resistant pathogens, excessive costs, and antibiotic-related adverse events, we suggest that AMP should be used only in selected circumstances such as in recipients older than 65 yr or when the body mass index (BMI) is > 35.