Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study

P W Schreiber; M Laager; K Boggian; D Neofytos; C van Delden; A Egli; M Dickenmann; C Hirzel; O Manuel; M Koller; S Rossi; B Schmied; L Gürke; M Matter; T Berney; O de Rougemont; S P Kuster; S Stampf; N J Mueller; Swiss Transplant Cohort Study

doi:10.1016/j.jhin.2022.07.009

Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study

J Hosp Infect. 2022 Oct:128:47-53. doi: 10.1016/j.jhin.2022.07.009. Epub 2022 Jul 14.

Authors

P W Schreiber¹, M Laager², K Boggian³, D Neofytos⁴, C van Delden⁴, A Egli⁵, M Dickenmann², C Hirzel⁶, O Manuel⁷, M Koller², S Rossi², B Schmied⁸, L Gürke⁹, M Matter¹⁰, T Berney¹¹, O de Rougemont¹², S P Kuster¹³, S Stampf², N J Mueller¹⁴; Swiss Transplant Cohort Study

Collaborators

Swiss Transplant Cohort Study:
P Amico, J-D Aubert, V Banz, S Beckmann, G Beldi, C Berger, E Berishvili, A Berzigotti, I Binet, P-Y Bochud, S Branca, H Bucher, E Catana, A Cairoli, Y Chalandon, S De Geest, O De Rougemont, S De Seigneux, M Dickenmann, J L Dreifuss, M Duchosal, T Fehr, S Ferrari-Lacraz, C Garzoni, D Golshayan, N Goossens, F H J Halter, D Heim, C Hess, S Hillinger, H H Hirsch, P Hirt, G Hofbauer, U Huynh-Do, F Immer, M Koller, M Laager, B Laesser, F Lamoth, R Lehmann, A Leichtle, O Manuel, H P Marti, M Martinelli, V McLin, K Mellac, A Merçay, K Mettler, A Müller, N J Mueller, U Müller-Arndt, B Müllhaupt, M Nägeli, G Oldani, M Pascual, J Passweg, R Pazeller, K Posfay-Barbe, J Rick, A Rosselet, S Rossi, S Rothlin, F Ruschitzka, T Schachtner, U Schanz, S Schaub, A Scherrer, A Schnyder, M Schuurmans, S Schwab, T Sengstag, F Simonetta, S Stampf, J Steiger, G Stirnimann, U Stürzinger, C Van Delden, J-P Venetz, J Villard, J Vionnet, M Wick, M Wilhelm, P Yerly

Affiliations

¹ Division of Infectious Diseases and Hospital Epidemiology and University Zurich, University Hospital Zurich, Zurich, Switzerland. Electronic address: peterwerner.schreiber@usz.ch.
² Division of Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland.
³ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
⁴ Transplant Infectious Diseases Unit, Service of Infectious Diseases, Department of Medicine, University Hospitals Geneva, University of Geneva, Geneva, Switzerland.
⁵ Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
⁶ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Bern, Bern, Switzerland.
⁷ Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland.
⁸ Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St Gallen, St Gallen, Switzerland.
⁹ Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland.
¹⁰ Visceral Surgery Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹¹ Department of Surgery, Division of Abdominal and Transplantation Surgery, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
¹² Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
¹³ Division of Infectious Diseases and Hospital Epidemiology and University Zurich, University Hospital Zurich, Zurich, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
¹⁴ Division of Infectious Diseases and Hospital Epidemiology and University Zurich, University Hospital Zurich, Zurich, Switzerland.

PMID: 35840001
DOI: 10.1016/j.jhin.2022.07.009

Abstract

Background: Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant recipients.

Aim: To determine incidence, risk factors for SSI and its association with post-transplant outcomes and pancreas transplant (P-Tx) recipients.

Methods: Adult simultaneous kidney-pancreas transplantation (SPK-T) and P-Tx recipients with a follow-up of at least 90 days were identified in the Swiss Transplant Cohort Study (STCS) dataset. Except for the categorization of SSIs according to Centers for Disease Control and Prevention (CDC) criteria, all other data were prospectively collected. Risk factors for SSI were investigated with logistic regression. A Weibull accelerated failure-time model was applied to address the impact of SSI on length of stay, correcting for transplant-related complications and delayed graft function.

Findings: Of 130 transplant recipients, 108 SPK-Tx and 22 P-Tx, 18 (14%) individuals developed SSI within the first 90 days after transplantation. Deep incisional (seven, 38.9%) and organ/space infections (eight, 44.4%) predominated. In the majority of SSIs (11, 61.1%; two SSIs with simultaneous identification of fungal pathogens) bacteria were detected with Enterococcus spp. being most frequent. The median duration of hospitalization after transplantation was significantly longer in recipients with SSI (median: 26 days; interquartile range (IQR): 19-44) than in patients without SSI (median: 17 days; IQR: 12-25; P = 0.002). In multivariate analysis, SSI was significantly associated with increased length of stay and prolonged the duration of hospitalization by 36% (95% confidence interval: 4-79).

Conclusion: SSI after SPK-Tx and P-Tx occurred at a frequency of 14%. Among pathogens, Enterococcus spp. predominated. SSI was independently associated with a longer hospitalization after transplantation.

Keywords: Hospital-acquired infection; Pancreas transplantation; Simultaneous kidney–pancreas transplantation; Surgical site infection.

MeSH terms

Adult
Cohort Studies
Humans
Kidney
Kidney Transplantation* / adverse effects
Pancreas
Pancreas Transplantation* / adverse effects
Risk Factors
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Switzerland / epidemiology