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Previous issue date: 2007 / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Objetivo: Descrever os aspectos epidemiologicos e clinicos das infeccoes de sitio cirurgico pos-transplante renal, avaliando os fatores de risco, assim como o impacto na funcao e sobrevida do enxerto. Metodos: Trata-se de um estudo retrospectivo do tipo caso-controle, realizado no Hospital do Rim e Hipertensao (afiliado a Universidade Federal de São Paulo), que descreveu as caracteristicas epidemiologicas e clinicas das infeccoes de sitio cirurgico pos-transplante renal, assim como os fatores de risco e a avaliacao do impacto na funcao e sobrevida do enxerto durante um ano e seis meses. Atraves dos registros de Vigilancia do Servico de Controle de Infeccao Hospitalar desta instituicao, foi possivel obter os dados do grupo com infeccao de sitio cirurgico (grupo caso). O pareamento com o grupo controle (1:1) foi realizado atraves das variaveis idade e genero. Resultados: No periodo de abril de 2001 a dezembro de 2004, foram realizados 1939 transplantes renais, sendo 120 pacientes no grupo caso e seus respectivos controles, totalizando 145 casos de infeccoes de sitio cirurgico pos-transplante renal, com predominio do sexo masculino (56,7 por cento) e media etaria de 45,5 anos. Quanto ao tipo de transplante, 49,2 por cento foram de doadores falecidos, com 16,7 por cento de intercorrencias no intra-operatorio e predominio do uso de cefalosporinas durante 48 horas (87,5 por cento) como profilaxia cirurgica. A presenca de rejeicao aguda foi notada em 40 por cento, apesar do uso de inducao com imunossupressores em 21,70 por cento. Outras complicacoes foram observadas, como por exemplo, as infeccoes do trato urinario (53,3 por cento) e citomegalovirose (25 por cento), disfuncao precoce do enxerto (41,7 por cento) e DMPT (26,7 por cento). Na classificacao das ISCPT, o tipo incisional superficial...(au) / Objectives: To describe the clinical and epidemiological aspects, risk factors and impact on graft function of surgical wound infections in kidney transplant patients. Methods: Retrospective study was conducted at Hospital do Rim e Hipertensão, affiliated to the Federal University of São Paulo. Epidemiological and clinical characteristics of the surgical wound infection were described by chart review. The risk factors and impact on graft function were analyzed in case-control study. The Infection
Control Service of Hospital do Rim e Hipertensão provided information on surveillance
of surgical wound infection (case group). The control group was matched by gender and
age.
Results: Between 1 April 2001 and 31 December 2004, 1939 kidney transplants were
performed at the Hospital do Rim e Hipertensão. In the case group, 120 patients were
enrolled with 145 surgical wound infections after kidney transplant. Male prevalence was
56,7% and median age of 45,5 years. Deceased donors were 49,2%, with 16,7% of
intra-operative complications. Surgical prophylaxis with cephalosporins during 48 hours
after surgery was present in 87,5% of all patients. Acute rejection was noticed in 40%, in
spite of the high immunosuppressive induction (21,7%). The other complications were
observed, as for instance urinary tract infection (53,3%), cytomegalovirus infection
(25%), delayed graf function (41,7%) and post-transplant mellitus diabetes (26,7%).
Most wound infections were superficial (73,1%) and the medium time for the first
episode was 11,85 days post-transplant. In 37,9% of the infections, more than one
agent was recovered. Gram-positive agents caused 62,9% of the infections. However,
the gram-negative bacteria predominated in second episode of wound infection (58,8%).
The medium time of treatment in the first episode was 15,4 days, while in the second
99
episode was 17,5 days. The mortality was 0,8%. Stepwise logistics regression identified
surgical intervention after renal transplant (OR = 156,1; 95% CI 32,76 – 743,86; p =
0,001), chronic glomerulonephritis (OR = 40,9; 95% CI 8,7 – 191,8; p = 0,001), acute
rejection (OR = 8,3; 95% CI 2,6 – 26,6; p = 0,003), delayed graft function (OR = 9,4;
95% CI 3,0 – 29,3; p = 0,001), mellitus diabetes (OR = 5,8; 95% CI 1,3 – 26,1; p = 0,05)
and body mass index (OR = 1,36; 95% CI 1,2 – 1,5; p = 0,001) as independent risk
factors. No impact on graft function and survival was detected.
Conclusions: Surgical wound infection after kidney transplant had no impact on graft
function or survival with low mortality and high morbidity. The knowledge of risk factors
is important for prevention and early detection of these infections, improving infectious
management in kidney transplant patients. / CNPq: 132512/2005-0 / BV UNIFESP: Teses e dissertações
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unifesp.br:11600/23415 |
| Date | January 2007 |
| Creators | Menezes, Fernando Gatti de [UNIFESP] |
| Contributors | Universidade Federal de São Paulo (UNIFESP), Sato, Emilia Inoue [UNIFESP] |
| Publisher | Universidade Federal de São Paulo (UNIFESP) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | 120 f. |
| Source | reponame:Repositório Institucional da UNIFESP, instname:Universidade Federal de São Paulo, instacron:UNIFESP |
| Rights | info:eu-repo/semantics/openAccess |
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