Antibiotic therapy in case of positive cultures of kidney transplant preservation fluid: a nationwide survey of prescribing practices

• Published in: European journal of clinical microbiology & infectious diseases Vol. 39; no. 5; pp. 915 - 921
• Main Authors: Le Berre, N., Ladrière, M., Corbel, A., Remen, T., Durin, L., Frimat, L., Thilly, N., Pulcini, C.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2020; Springer Nature B.V; Springer Verlag
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotic Prophylaxis; Antibiotics; Attitude of Health Personnel; Bacteria - drug effects; Bacteria - isolation & purification; Bacterial Infections - drug therapy; Bacterial Infections - etiology; Biomedical and Life Sciences; Biomedicine; Cross-Sectional Studies; Diabetes mellitus; France; Guideline Adherence; Guidelines; Humans; Internal Medicine; Kidney; Kidney transplantation; Kidney Transplantation - adverse effects; Kidney transplants; Kidneys; Klebsiella; Life Sciences; Medical Microbiology; Methicillin; Organ Preservation Solutions - analysis; Original Article; Patients; Perfusion; Perfusion fluids; Physicians; Polls & surveys; Practice Patterns, Physicians' - statistics & numerical data; Preservation; Prophylaxis; Pseudomonas aeruginosa; Santé publique et épidémiologie; Surveys and Questionnaires; France
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-019-03808-4

Our survey aimed to describe current prescribing practices for perioperative antibiotic prophylaxis in French kidney transplant centers. We conducted a nationwide cross-sectional clinical vignette-based survey that we sent via email to hospital practitioners involved in perioperative management of kidney transplant patients (KTR). Nearly half of practitioners contacted (182/427, 42.6%) were respondents. A total of 167 getting enough kidney transplant activity were eligible for the survey. The response rate was 50.7% (68/134) among interns and 33.8% (99/293) among seniors. Positive perfusion fluids (PF) cultures for methicillin-susceptible
Staphylococcus aureus
were associated with antibiotic prescribing in 35% of cases, with no difference in prescribing in patients with diabetes, obesity, or delayed graft function. Antibiotic prescribing was most frequent with
Pseudomonas aeruginosa
(67%) and
Klebsiella pneumoniae
strains producing extended spectrum β-lactamases (57%). About 77%, 16%, and 13% of respondents, respectively, reported the existence of local practice guidelines for surgical antibiotic prophylaxis, a standardized approach for antibiotic prescribing in case of positive kidney transplant PF cultures, and local practice guidelines for systematical antibiotic prophylaxis in the early post-transplant period. In France, antibiotic prophylaxis practices in the perioperative kidney transplant period are very heterogeneous. To prevent unnecessary prescribing and bacterial resistance, evidence-based practice guidelines should be developed.