Targeted monitoring on healthcareassociated infection in donation after cardiac death kidney transplant recipients

Abstract:

ObjectiveTo explore the incidence and pathogens causing healthcareassociated infection(HAI) in donation after cardiac death(DCD) kidney transplant recipients, provide theoretical basis for formulating corresponding prevention and control measures. MethodsTargeted monitoring on HAI in DCD kidney transplant recipients from January 2014 to December 2016 was studied prospectively, incidence and pathogenic characteristics of HAI in DCD kidney transplant recipients were analyzed. ResultsFrom January 2014 to December 2016, 313 DCD kidney transplant recipients were monitored, 63 patients had 48 times of HAI, HAI rate and HAI case rate were 15.34% and 20.13% respectively. HAI rate in 2016, 2014, and 2015 were 10.11%（19/188）， 28.57%（14/49），and 19.74%（15/76）respectively, HAI rates were statistically significant among different years（P＜0.05）. The top three infection sites were lower respiratory tract (22/63, 34.92%), surgical site (16/63, 25.39%), and blood system (11/63, 17.46%). A total of 42 strains of pathogens were isolated, mainly gramnegative bacteria (n=27, 64.29%), followed by fungi (n=9, 21.43%) and grampositive bacteria (n=6, 14.28%); the top three pathogens were Klebsiella pneumoniae (n=9, 21.43%), Candida tropicalis (n=7, 16.67%), and Escherichia coli (n=5, 11.90%). Among 42 strains of pathogens, 15(35.71%) were multidrugresistant organisms(MDROs), 10(66.67%) of which were gramnegative bacteria, mostly were carbapenemresistant Enterobacteriaceae(n=4) and Acinetobacter spp.(n=3); 5 strains (33.33%) were grampositive bacteria, mainly were methicillinresistant Staphylococcus aureus(n=3). ConclusionHAI incidence in DCD kidney transplant recipients is high, comprehensive intervention measures should be taken to strengthen prevention and control of lower respiratory tract infection, surgical site infection, and bloodstream infection. Prevention and control of MDRO infection should be strengthened, antimicrobial use strategy should be improved to reduce the emergence of carbapenemresistant strains.