New Recommendations for Managing Surgical Site Infections in Solid Organ Transplantation

Surgical site infections (SSIs) can occur in as many as 53% of transplant patients depending on the affected organ, and these infections are increasingly caused by multidrug-resistant organisms, leading to higher mortality and morbidity.

The American Society of Transplantation Infectious Diseases Community of Practice has issued a new section of guidelines as part of its series of evidence-based graded recommendations for the diagnosis, prevention, and management of SSIs.

Lilian Abbo, MD, FIDSA, chief of Infection Prevention and Antimicrobial Stewardship with Jackson Health System and associate professor of infectious diseases at University of Miami’s Miller School of Medicine, shared the key updates in an interview with Contagion®.

“For the first time the ID COP is addressing the evidence-based recommendations for the prevention of SSIs by transplant organ,” she said. “The recommendations incorporate the best available evidence in nasal decolonization, skin preparation and bathing, and the selection of targeted antimicrobial prophylaxis in transplant patients…We incorporated recommendations regarding the selection of antimicrobial therapy in patients with colonization or previous infection at the time of organ transplantation, [as well as] suggested approaches to the management of post-operative SSIs.”

For hospitalized pre-solid organ transplant patients, the ID COP recommends daily chlorhexidine gluconate 2.0% bathing during the hospital stay, at the time of organ offer, and post-operatively.

The investigators also tackle the complex subject of perioperative antibiotic prophylaxis. Though there are no formal recommendations outside of the Infectious Diseases Society of America, American Society of Health-System Pharmacists, Surgical Infection Society, and Society for Healthcare Epidemiology of America guidelines, the ID COP research team offers a cumulative review of recent literature and a stratified breakdown by transplant organ.

“Though the choice of antibiotic regimen is of great significance, accurate timing of antibiotic dosing is equally important,” the committee advises. “Peri-operative antibiotics have the most impact on reducing SSIs when administered within 60 minutes of surgical incision. However, in a recent meta-analysis of 14 studies including over 54,000 patients, the authors point out that there is no strong evidence to substantiate the 60 min timeframe and concluded that the lowest risk of SSIs is within < 120 min.”

Perioperative antibiotics should be dosed by weight and re-dosing may be necessary during the procedure if it lasts more than 2 half-lives of the drug or if there is excessive blood loss during the surgery.

The committee also offers specific peri-operative antibiotic prophylaxis regimens broken down by organ transplant type, such as renal, pancreas, liver, heart, and lung, among others.