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[The perfusate culture--bacteriologic monitoring of kidney grafts]
Abstract:
Since the kidney recipient's immune system is entirely suppressed, any bacterial contamination from a graft might be hazardous. Major statistics [1,3,4,5] reveal a mortality as high as 10% due to infectious and gastrointestinal complications. From July 1979 to December 1983 114 kidney grafts have been done in our center. After transplantation none of the patients died as a result of complications due to infection. Microbiologic examination of the perfusate is obligatory to detect contamination. It was used in 145 donor nephrectomies; 28% of the perfusate culture samples were positive: In 4 of 5 cases (81%) the bacteria isolated were of the non-pathogenic type seen in the normal flora of the skin (Staphylococcus epidermidis). Introduction of cover drapes lowered the positive culture rate to 8%. Isolation of S. epidermidis after desinfection of the skin (6x) with 70% spore-free alcohol is proof of the extraordinary sensitivity of the method used. The outstanding clinical importance of this method is the rapid information obtained on any contamination and the early suggestion concerning the first choice of antibiotic. Though E.coli and Pseudomonas aeruginosa were found in the culture, no clinical infection was seen under adequate antimicrobial therapy. Among 114 kidney transplantations in our center no patient died of bacterial infection. Our experience points out that the effect of general antibiotic prophylaxis is negligible. Instead, the effect of early application of antibiotics in accordance with the results of the perfusate culture is superior.
Insights
Kidney transplant recipients are vulnerable to infection. Perfusate culture analysis and targeted antibiotic therapy, rather than general prophylaxis, significantly reduced infection-related mortality in kidney transplant patients.
Area of Science:
- Nephrology
- Microbiology
- Transplantation Immunology
Context:
- Kidney transplant recipients have suppressed immune systems, making them susceptible to bacterial contamination from grafts.
- Infectious complications pose a significant mortality risk (up to 10%) in transplant patients.
- Previous studies highlight the dangers of graft contamination in immunosuppressed individuals.
Purpose:
- To evaluate the effectiveness of perfusate microbiologic examination in detecting contamination during kidney donation.
- To assess the impact of targeted antibiotic therapy based on perfusate culture results on patient outcomes.
- To compare the efficacy of targeted therapy versus general antibiotic prophylaxis in preventing post-transplant infections.
Summary:
- Microbiologic examination of perfusate from 145 donor nephrectomies revealed 28% positive cultures, predominantly *Staphylococcus epidermidis*.
- Implementing cover drapes reduced positive culture rates to 8%.
- No mortality from infection occurred in 114 kidney transplantations when early, culture-guided antibiotic therapy was employed, contrasting with the limited benefit of general prophylaxis.
Impact:
- Demonstrates the clinical importance of rapid perfusate culture analysis for early contamination detection and antibiotic selection.
- Highlights the superiority of targeted antimicrobial therapy over general prophylaxis in preventing fatal infections post-kidney transplantation.
- Suggests a protocol for minimizing infectious complications in kidney transplant recipients through meticulous graft assessment and tailored treatment.