Background: Donor derived infections (DDIs) can lead to significant morbidity and mortality in solid organ transplant patients. In recent years, the disparity between the need for organs and the availability of donors has led most transplant centers to loosen their donor selection criteria and accept more allografts from donors with positive cultures. Data are limited regarding the management of kidney recipients from donors with positive cultures and are often conflicting on whether to use pre-emptive antimicrobials for non-bloodstream positive urine cultures.

Objective: The purpose of this study was to analyze our experience using kidneys from donors with urine-only positive cultures and the incidence of transmission events at a large tertiary academic hospital.

Methods: Single center retrospective study of kidney transplant recipients who received allografts from donors with urine-only positive cultures (i.e., in the absence of bacteremia in the donor) from September 2011 to August 2015. Transplant outcomes and incidence of infections, including DDI, occurring within three first months post-transplant were analyzed.

Results: Forty kidney transplant recipients were identified for inclusion in the study. Twenty-nine (73%) recipients with positive donor urine cultures were treated pre-emptively after transplantation. Infection within three months was evident in 16 (40%) patients: 10 out of 29 (35%) in the pre-emptive group and 6 out of 11 (55%) in the not-treatment group (p=0.29). Among those 16 cases, 12 (75%) were urinary tract infections, while three (19%) were blood stream infections, and one (6%) was an upper respiratory tract infection. Evidence of DDI occurred only in two recipients, one in each group. There was no observed difference in one-year graft and patient survival between the two groups.

Conclusions: Although these observations require further validation in larger prospective studies, our data suggests that pre-emptive antibiotic therapy does not impact outcomes post-transplant and is of limited value in kidney recipients of urine-only positive donor cultures.

CITATION INFORMATION: Cabrera P., Centeno A., Revollo J., Camargo J. The Role of Pre-Emptive Antibiotic Therapy in Kidney Recipients of Donors with Urine-Only Positive Cultures Am J Transplant. 2017;17 (suppl 3).

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