Culture of Transplant Perfusate Using BACTEC Technology and Antibiotic Prophylaxis Influences Wound Complications Within a Kidney Transplant and SPK Transplant Cohort

• Published in: Transplantation proceedings 2020-12, Vol.52 (10), p.2909-2915
• Main Authors: Shahrestani, Sara, Chen, Sharon, Hitos, Kerry, Hameed, Ahmer, Davies, Sussan, Goire, Namraj, Pleass, Henry C., Hawthorne, Wayne J.
• Format: Article
• Language: English
• Subjects: Adult; Antibiotic Prophylaxis; Cohort Studies; Culture Media; Drug Contamination; Female; Humans; Kidney Transplantation - adverse effects; Male; Organ Preservation Solutions - adverse effects; Wound Infection - etiology; Wound Infection - prevention & control; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.03.026

Routine screening for microbial contamination in organ recovery perfusion transport solution (ORPTS) is by microbiological culture without broth enrichment. Our aim was to examine the clinical utility of broth enrichment of perfusion solution, through use of BACTEC (Becton Dickinson) blood culture media, in preventing wound complications for transplant recipients in comparison with culture without enrichment. We prospectively collected samples of ORPTS of 395 kidney (n = 250) or simultaneous pancreas-kidney (SPK, n = 145) donors over a 7-year period. Results of culture with and without broth enrichment (n = 285) using BACTEC blood culture media were examined to compare the sensitivity of BACTEC with non-BACTEC methods. We then conducted a paired analysis of 110 recipients with both BACTEC and non-BACTEC culture organ perfusion media. We examined the rates of wound infection and whether the use of targeted antimicrobials reduced infections in the BACTEC group and recipients with both types of cultures. Of 395 patients with cultures of ORPTS, first, the results of 79 cultures performed using BACTEC media only were compared with 206 non-BACTEC cultures (n = 285). Second, 110 cultures were performed using both methods. For the first part of the study, BACTEC media detected significantly greater microbial growth than non-BACTEC methods (n = 79, 64.6% vs n = 206, 14.6%; P < .001). In the 110 patients with both BACTEC (52.3%) and non-BACTEC cultures (9.9%), there was significantly higher sensitivity of the BACTEC method (P < .001); 68.2% of these patients had antimicrobial cover in the days immediately following transplant sufficient to cover the cultured organism. In the patients with appropriate antimicrobial cover, the rate of recipient wound infection was significantly reduced (P = .003). Routine screening of ORPTS with BACTEC broth enrichment should always be employed. When paired with antimicrobial prophylaxis, it has the potential to significantly reduce the risk of recipient wound infection. •BACTEC-enabled microbiological culture provides superior sensitivity to non-BACTEC culture methods for screening ORPTS for microbial growth.•Patients at increased risk for surgical site infections include SPK recipients, patients with organs from an older donor, and older recipients.•Microbial results from BACTEC culture, used in conjunction with targeted antimicrobial prophylaxis, can reduce the frequency of transplant surgical site infections.