One-shot versus multidose perioperative antibiotic prophylaxis after kidney transplantation: A randomized, controlled clinical trial

• Published in: Surgery 2015-01, Vol.157 (1), p.104-110
• Main Authors: Orlando, Giuseppe, MD, PhD, Manzia, Tommaso Maria, MD, PhD, Sorge, Roberto, PhD, Iaria, Giuseppe, MD, PhD, Angelico, Roberta, MD, Sforza, Daniele, MD, Toti, Luca, MD, PhD, Peloso, Andrea, MD, Patel, Timil, MD, Katari, Ravi, BS, Zambon, Joao Paulo, MD, PhD, Maida, Andrea, MD, Salerno, Maria Paola, MD, Clemente, Katia, BS, Di Cocco, Pierpaolo, MD, De Luca, Linda, MD, PhD, Tariciotti, Laura, MD, PhD, Famulari, Antonio, MD, Citterio, Franco, MD, Tisone, Giuseppe, MD, Pisani, Francesco, MD, Romagnoli, Jacopo, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Anti-Bacterial Agents - administration & dosage; Antibiotic Prophylaxis - methods; Cephalosporins - administration & dosage; Female; Humans; Kidney Transplantation; Male; Middle Aged; Perioperative Care; Surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2014.06.007

Background There is no consensus on the optimal perioperative antibiotic prophylaxis regimen for renal transplant recipients. Some studies have reported that irrigation of the wound at the time of closure without systemic antibiotics may suffice to minimize the risk for surgical site infection (SSI), but many centers still use long-term, multidose regimens in which antibiotics are administered until removal of foreign bodies occur, such as the urethral catheter, drain and central line. Methods We designed a prospective, randomized, multicenter, controlled trial to compare a single dose versus a multidose regimen of systemic antibiotic prophylaxis in adult, nondiabetic, non-morbidly obese patients undergoing renal transplantation. The primary endpoint was the incidence of SSI; the assessment of other infection in the first postoperative month was the secondary endpoint. Results Two hundred five patients were enrolled and randomized to receive either a single ( n  = 103) or multidose antibiotic regimen ( n  = 102) for prophylaxis. The incidences of SSI and urinary tract infection were similar in both groups. Conclusion As the dramatic increase in antibiotic resistance has mandated the implementation of global programs to optimize the use of antibiotic agents in humans, we believe that the single dose regimen is preferred, at least in nondiabetic, non-morbidly obese, adult renal transplant recipients.