Wide-spectrum antibiotic prophylaxis guarantees optimal outcomes in drowned donor kidney transplantation

ABSTRACT

Background

Drowned victims possibly obtain various pathogens from drowning sites. Using drowned renal donors to expand the donor pool still lacks consensus due to the potential risk of disease transmission.

Research design and methods

This retrospective study enrolled 38 drowned donor renal recipients in a large clinical center from August 2012 to February 2021. A 1:2 matched cohort was generated with donor demographics, including age, gender, BMI, and ICU durations. Donor microbiological results, recipient perioperative infections, and early post-transplant and first-year clinical outcomes were analyzed.

Results

Compared to the control group, drowned donors had significantly increased positive fungal cultures (36.84% vs.13.15%, p = 0.039). Recipients in the drowned group had significantly higher rates of gram-negative bacteria (GNB) and multidrug-resistant GNB infections (23.68% vs.5.26%, 18.42% vs. 3.95%, both p < 0.05). Other colonization and infections were also numerically more frequent in the drowned group. Drowned donor recipients receiving inadequate antibiotic prophylaxis had more perioperative bloodstream infections, higher DGF incidences, and more first-year respiratory tract infections and recipient loss than those receiving adequate prophylaxis (all p < 0.05). Clinical outcomes were similar between the adequate group and the control group.

Conclusions

Drowned donors could be suitable options under wide-spectrum and adequate antimicrobial prophylaxis.

KEYWORDS:

• Antibiotic prophylaxis
• drowned donor
• kidney transplantation
• multidrug resistant
• perioperative infection
• wide spectrum

Acknowledgments

The authors would like to thank all the clinical and nursing staff at Kidney Disease Center, The First Affiliated Hospital, Zhejiang University School of Medicine, who cared for the patients during hospitalisation and after discharge.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Conceptualization: Hong-Feng Huang, Xiao-Li Lin

Investigation: Xin-Yu Liu, Xiao-Ying Wu, Xi-Shao Xie, Guang-Jun Liu

Writing: Original Draft: Xiao-Li Lin

Writing: Review & Editing: Hong-Feng Huang, Xiao-Li Lin

Visualization: Jiang-Hua Chen, Jian-Yong Wu, Wen-Han Peng, Ren-Ding Wang

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2163237

Additional information

Funding

This work was supported by the National Natural Science Foundation of China (nos.82070767, 81770750).