Introduction

Infection is a common cause of morbidity and mortality after kidney transplantation. Despite careful pre-transplantation screening of donors and recipients, vaccination, prophylaxis, and antimicrobial use, controlling infection at the early transplant period remains challenging. We sought to extend the well-documented successes of ICU use decolonization by specifically evaluating the safety and efficacy of universal application with chlorhexidine and mupirocin to incident kidney transplant patients.

Methods

We compared a single center consecutive cohort of kidney transplant recipients who underwent universal decolonization from March 1, 2014 to October 31, 2014 with a cohort of transplanted patient from an era immediately prior to the institution of the decolonization protocol. Universal decolonization was performed using nasal mupirocin oint and daily chlorohexidine body wash (intervention group). The following clinical outcomes were assessed: Microbiologically proven clinical infection rate in 30 days, Staphylococcus aureus infection rate, readmission rate in 30 days and adverse outcomes.

Results

Twenty-six patients who underwent universal decolonization were compared to 44 patients in control group. Median age was 52 year old (IQR 40, 61) and 50 (71.4%) received deceased donor renal transplantation. Twelve (17.1%) had history of infection or colonization with multidrug resistant organism. Three (4.3%) microbiologically proven infections occurred; each of these in the control group (2 urinary tract infection and 1 wound infection) compared to none in intervention group. None had Staphlylococcus aureus infection. Twenty (29%) were readmitted in 30 days after discharge, 6 (23%) in intervention group and 14 (32%) in control group. None in intervention group had adverse effect from mupirocin and chlorohexidine use.

Conclusion

In our cohort of kidney transplant recipients, a significant number of patients had history of infection or colonization with multidrug resistant organisms. The use of a universal decolonization protocol was well-tolerated and appeared to be associated with a reduced incidence of nosocomial infections. Universal decolonization should be considered as an easy and safe component of an infection control regimen for kidney transplant recipients.

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