SURGICAL-WOUND INFECTION IN RENAL-TRANSPLANTATION - OUTCOME DATA IN 102 CONSECUTIVE PATIENTS WITHOUT PERIOPERATIVE SYSTEMIC ANTIBIOTIC COVERAGE

Background: The incidence of surgical wound infection in the presence of immunosuppression has been reported in the literature to approach 7 %. Perioperative systemic antibiotic therapy is routinely used to redu ce the occurrence of wound infections. This therapy is not without com plications, including adverse effects and development of resistant str ains. Design: Surgical wound infection rates during the first 100 days after renal transplantation were studied in 102 consecutive patients. Eighty-one patients underwent cadaveric transplantation and 21 patien ts underwent living-related donor transplantation from February 1, 199 1, to January 1, 1992. No systemic perioperative antibiotic coverage w as used, but local antibiotic irrigation was part of the perioperative protocol. Setting: Hahnemann University Hospital, Philadeiphia, Pa, i s a large, tertiary care center. Patients were initially hospitalized and were discharged during the 100-day follow-up period based on clini cal status and improvement in renal function. Patients: Twenty-seven ( 25%) of 102 patients had diabetes mellitus. Interventions: Induction i mmunosuppression consisted of azathioprine, prednisone, and anitlympho cyte globulin, while maintenance immunosuppression consisted of azathi oprine, prednisone, and cyclosporine. Acute allograft rejection episod es were treated with steroids and/or OKT3 (Ortho Pharmaceutical Group, Raritan, NJ) Results: Two surgical wound infections (2%) occurred. In both, infection was superficial, resolving with wound drainage and in travenous antibiotics. The surgical wound infection rate was not signi ficantly affected by age, sex, allograft source, or presence of diabet es mellitus. Conclusions: Despite immunosuppression, the incidence of surgical wound infection was minimal, comparing favorably to rates rep orted for renal transplantation with the use of systemic antibiotics. Possible explanations for the low incidence of surgical wound infectio ns include local wound irrigation, meticulous hemostasis, improved org an procurement techniques, and continuity in perioperative care.