Implementing a Systematic Quality Improvement Strategy to Reduce Cytomegalovirus Infection Following Kidney...

Area of Science:

• Nephrology
• Infectious Diseases
• Transplantation Immunology

Background:

• Cytomegalovirus (CMV) is a common opportunistic infection post-kidney transplant, impacting allograft function and patient health.
• The highest risk for CMV infection occurs within the first six months after transplantation.
• Current strategies for CMV infection surveillance and prophylaxis vary among transplant centers.

Purpose of the Study:

• To implement and evaluate a quality improvement project aimed at reducing CMV infection rates in kidney transplant recipients.
• To address the adverse effects of CMV infection on allograft function and patient well-being post-transplantation.

Main Methods:

• A baseline audit was conducted, followed by two plan-do-study-act cycles between August 2021 and April 2023.
• Interventions included integrating Cockcroft Gault creatinine clearance for valganciclovir dosing, providing dosing cards, enhancing healthcare professional awareness, offering valganciclovir prophylaxis to CMV seropositive recipients, and considering immunosuppression reduction.

Main Results:

• The overall CMV infection rate within six months post-transplant decreased significantly from 22.5% to 5.8%.
• Infection rates were reduced across all risk categories: donor-positive/recipient-negative, donor-positive/recipient-positive, and donor-negative/recipient-positive.
• The accuracy of valganciclovir dosing, based on Cockcroft Gault creatinine clearance, improved in clinical practice.

Conclusions:

• A multifaceted quality improvement strategy effectively reduced the incidence of CMV infection within six months post-kidney transplantation.
• Addressing key factors identified through baseline audits is crucial for managing CMV infection complexity and detrimental outcomes.
• Transplant centers should continuously monitor CMV infection rates and implement quality improvement initiatives.