Two years' Experience of Universal Postoperative Decolonization for Kidney Transplant Recipients

Abstract

Background. Infection is a common cause of morbidity and mortality after kidney transplantation. Despite careful pre-transplantation screening of donors and recipients, vaccination and immunoprophylaxis, controlling infection at the early transplant period remains challenging. We sought to extend the well-documented successes of decolonization described in the intensive care units evaluating the safety and efficacy of universal decolonization. Methods. We compared a single center consecutive cohort of kidney transplant recipients who underwent universal decolonization from March 1, 2014, to January 31, 2016, with a cohort of transplanted patients from an era immediately prior to the institution of such protocol. Universal decolonization included nasal mupirocin ointment and daily chlorohexidine body wash (intervention group). The following clinical outcomes were assessed: Microbiologically proven clinical infection rate in 30 days, Staphylococcus aureus infection rate, 30-day readmission rate and adverse drug events. Results. Seventy-eight patients who underwent universal decolonization were compared to 43 patients in the control group. Median age was 52 years (IQR 40, 61) and 94 (77.7%) patients received a deceased donor renal transplant. Sixteen (13.2%) had a history of infection or colonization with a multidrug resistant organism. Ten (8.3%) microbiologically proven infections occurred in the 30 days after discharge; 7 (9%) in the intervention group compared to three (7%) in the control group. Only one had Staphylococcus aureus infection. Forty-five (37.2%) were readmitted in 30 days after discharge, 31 (39.7%) in intervention group, and 14 (32.6%) in control group. No one in intervention group had adverse drug event from mupirocin and chlorohexidine use. Conclusion. In our cohort of kidney transplant recipients, a significant number of patients had a history of infection or colonization with multidrug resistant organisms. A universal decolonization protocol was successfully implemented and was well tolerated by all patients. Despite successful implementation we did not observe any significant differences in infection rates between treated patients and historical controls. Further study is warranted.