Low predictive value of positive transplant perfusion fluid cultures for diagnosing postoperative infections in kidney and kidney–pancreas transplantation
- Meaghan P Cotter1,2,
- Elizabeth Smyth2,
- Joanne O'Gorman1,2,
- Sarah Browne3,
- David P Hickey4,
- Hilary Humphreys1,2
- 1Department of Microbiology, Beaumont Hospital, Dublin, Ireland
- 2Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Dublin, Ireland
- 3Division of Nephrology, University of British Columbia, Vancouver, Canada
- 4Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland
- Correspondence to Dr Meaghan Cotter, Department of Clinical Microbiology, Mater Misericordiae Hospital, Eccles Street, Dublin 3, Ireland;
- Accepted 26 July 2012
- Published Online First 22 August 2012
Aims Infection following transplantation is a cause of morbidity and mortality. Perfusion fluid (PF) used to preserve organs between recovery and transplantation represents a medium suitable for the growth of microbes. We evaluated the relevance of positive growth from PF sampled before the implantation of kidney or kidney–pancreas (KP) allografts.
Methods Between January 2007 and January 2011, 548 kidney/KP transplants were performed in our centre. A retrospective review of patient records with culture-positive PF was performed.
Results PF was received from 483 (88%) patients, of which 35 (7%, 95% CI 5.3% to 9.9%) were positive for bacteria (31/483, 6.4%, 95% CI 4.6% to 9.8%) and fungi (4/483, 0.8%, 95% CI 0.3% to 2.1%). Thirty-two of the 35 culture-positive PF (91.4%, 95% CI 77.6% to 97%) were considered insignificant. The remaining three patients developed sepsis postoperatively, which was considered to be possibly related to growth in PF; Escherichia coli in one and Klebsiella pneumoniae in two. Of the non-skin flora bacteria cultured from PF, six were resistant to the prophylactic antibiotic given intraoperatively, but only one developed infection postoperatively (E coli, resistant to the co-amoxiclav).
Conclusions Significant attributable morbidity associated with PF-positive culture results was relatively rare. Culture of organisms other than Enterobacteriaceae or fungi are likely to represent contamination.