*Purpose: Utilization of organs from infected donors carries the risk of transmission of the donor organism to the recipient. While antimicrobials are recommended in recipients for 7 to 14 days, the optimal duration is unknown. This study compared the incidence of clinical failure in kidney transplant recipients (KTR) receiving a short (<7 days) (SC) vs long course (>7 days) (LC) of antimicrobial therapy.

*Methods: This was a retrospective single center study. Adult deceased donor KTR from 10/2011 to 11/2019 were included if the recipient was treated for a positive donor blood or urine culture. KTR were excluded if they received a multi-organ transplant, donor culture data was unavailable, or the donor had a documented complicated infection. The primary outcome was 30-day incidence of clinical failure defined as rehospitalization with receipt of antimicrobials, resumption of antimicrobials for the original donor-derived infection, all-cause mortality, or graft loss. Secondary objectives included the incidence of Clostridioides difficile infection (CDI), multidrug resistant organisms (MDRO), and adverse effects from antimicrobials.

*Results: A total of 81 KTR were included [Table 1]. Of the donor cultures, 40 were blood, 40 were urine, and both were positive in one donor. The majority of organisms were gram positive (54%). The most commonly prescribed initial therapy was a penicillin (31%) and a fluoroquinolone (28%) was the main step-down therapy [Table 2]. No difference was detected in the clinical failure composite between the SC vs LC groups (32% vs 26%, p=0.55) and no documented transmission was detected. However, more recipients in the LC group had a CDI (14% vs 0%, p=0.021) and more recipients in the SC group developed a MDRO (26% vs 9%, p=0.048). The groups were similar for the secondary outcomes of acute kidney injury, hepatotoxicity, gastrointestinal toxicity, and rash.

*Conclusions: The incidence of clinical failure was not significantly different between the SC and LC groups. However, using shorter durations of antimicrobials may minimize the incidence of CDI, while maintaining the ability to prevent donor-derived infections.

« Back to 2021 American Transplant Congress