Surgical site infections after kidney transplantation are independently associated with graft loss

Peter W Schreiber; Linard D Hoessly; Katia Boggian; Dionysios Neofytos; Christian van Delden; Adrian Egli; Michael Dickenmann; Cédric Hirzel; Oriol Manuel; Michael Koller; Simona Rossi; Vanessa Banz; Bruno Schmied; Lorenz Guerke; Maurice Matter; Olivier de Rougemont; Marco Bonani; Déla Golshayan; Aurelia Schnyder; Daniel Sidler; Fadi Haidar; Stefan P Kuster; Susanne Stampf; Nicolas J Mueller; members of the Swiss Transplant Cohort Study (STCS)

doi:10.1016/j.ajt.2023.11.013

Surgical site infections after kidney transplantation are independently associated with graft loss

Am J Transplant. 2023 Nov 30:S1600-6135(23)00875-4. doi: 10.1016/j.ajt.2023.11.013. Online ahead of print.

Authors

Peter W Schreiber¹, Linard D Hoessly², Katia Boggian³, Dionysios Neofytos⁴, Christian van Delden⁴, Adrian Egli⁵, Michael Dickenmann², Cédric Hirzel⁶, Oriol Manuel⁷, Michael Koller², Simona Rossi², Vanessa Banz⁸, Bruno Schmied⁹, Lorenz Guerke¹⁰, Maurice Matter¹¹, Olivier de Rougemont¹², Marco Bonani¹³, Déla Golshayan¹⁴, Aurelia Schnyder¹⁵, Daniel Sidler¹⁶, Fadi Haidar¹⁷, Stefan P Kuster¹⁸, Susanne Stampf², Nicolas J Mueller¹⁸; members of the Swiss Transplant Cohort Study (STCS)

Collaborators

members of the Swiss Transplant Cohort Study (STCS):
Patrizia Amico, John-David Aubert, Vanessa Banz, Sonja Beckmann, Guido Beldi, Christoph Berger, Ekaterine Berishvili, Annalisa Berzigotti, Isabelle Binet, Pierre-Yves Bochud, Sanda Branca, Heiner Bucher, Emmanuelle Catana, Anne Cairoli, Yves Chalandon, Sabina De Geest, Olivier De Rougemont, Sophie De Seigneux, Michael Dickenmann, Joëlle Lynn Dreifuss, Michel Duchosal, Thomas Fehr, Sylvie Ferrari-Lacraz, Christian Garzoni, Déla Golshayan, Nicolas Goossens, Fadi Haidar, Jörg Halter, Dominik Heim, Christoph Hess, Sven Hillinger, Hans H Hirsch, Patricia Hirt, Linard Hoessly, Günther Hofbauer, Uyen Huynh-Do, Franz Immer, Michael Koller, Bettina Laesser, Frédéric Lamoth, Roger Lehmann, Alexander Leichtle, Oriol Manuel, Hans-Peter Marti, Michele Martinelli, Valérie McLin, Katell Mellac, Aurélia Merçay, Karin Mettler, Nicolas J Mueller, Ulrike Müller-Arndt, Beat Müllhaupt, Mirjam Nägeli, Graziano Oldani, Manuel Pascual, Jakob Passweg, Rosemarie Pazeller, Klara Posfay-Barbe, Juliane Rick, Anne Rosselet, Simona Rossi, Silvia Rothlin, Frank Ruschitzka, Thomas Schachtner, Stefan Schaub, Alexandra Scherrer, Aurelia Schnyder, Macé Schuurmans, Simon Schwab, Thierry Sengstag, Federico Simonetta, Susanne Stampf, Jürg Steiger, Guido Stirnimann, Ueli Stürzinger, Christian Van Delden, Jean-Pierre Venetz, Jean Villard, Julien Vionnet, Madeleine Wick, Markus Wilhelm, Patrick Yerly

Affiliations

¹ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland. Electronic address: peterwerner.schreiber@usz.ch.
² Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
³ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
⁴ Transplant Infectious Diseases Unit, Service of Infectious Diseases, University Hospitals Geneva, University of Geneva, Geneva, Switzerland.
⁵ Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.
⁶ Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
⁷ Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
⁸ University Clinic for Visceral Surgery and Medicine, University Hospital Bern and University of Bern, Bern, Switzerland.
⁹ Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
¹⁰ Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
¹¹ Visceral Surgery Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹² Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
¹³ Division of Nephrology, University Hospital Zurich, Zurich, Switzerland.
¹⁴ Transplantation Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹⁵ Clinic for Nephrology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland.
¹⁶ Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, Bern, Switzerland.
¹⁷ Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland.
¹⁸ Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland.

PMID: 38042413
DOI: 10.1016/j.ajt.2023.11.013

Abstract

Surgical site infections (SSIs) are common health care-associated infections. SSIs after kidney transplantation (K-Tx) can endanger patient and allograft survival. Multicenter studies on this early posttransplant complication are scarce. We analyzed consecutive adult K-Tx recipients enrolled in the Swiss Transplant Cohort Study who received a K-Tx between May 2008 and September 2020. All data were prospectively collected with the exception of the categorization of SSI which was performed retrospectively according to the Centers for Disease Control and Prevention criteria. A total of 58 out of 3059 (1.9%) K-Tx recipients were affected by SSIs. Deep incisional (15, 25.9%) and organ/space infections (34, 58.6%) predominated. In the majority of SSIs (52, 89.6%), bacteria were detected, most frequently Escherichia coli (15, 28.9%), Enterococcus spp. (14, 26.9%), and coagulase-negative staphylococci (13, 25.0%). A BMI ≥25 kg/m² (multivariable OR 2.16, 95% CI 1.07-4.34, P = .023) and delayed graft function (multivariable OR 2.88, 95% CI 1.56-5.34, P = .001) were independent risk factors for SSI. In Cox proportional hazard models, SSI was independently associated with graft loss (multivariable HR 3.75, 95% CI 1.35-10.38, P = .011). In conclusion, SSI was a rare complication after K-Tx. BMI ≥25 kg/m² and delayed graft function were independent risk factors. SSIs were independently associated with graft loss.

Keywords: graft loss; health care-associated infection; kidney transplantation; surgical site infection.