Antimicrobial Prophylaxis in Kidney Transplant Donors “Lesser the Better”

Introduction: Preoperative antimicrobial prophylaxis is crucial for reducing surgical site infections (SSIs) in kidney transplant donors. Purpose of the study was to compare the effects of various doses of antimicrobial prophylaxis in patients undergoing kidney transplants to reduce the incidence of SSIs.Methods: This retrospective cohort study was confined to 632 living kidney donors at the Pakistan Kidney and Liver Institute & Research Centre (PKLI & RC), Lahore, Pakistan between May 2018 and April 2024. Consequently, the study incorporated donors who underwent antimicrobial prophylaxis within the period of surgery management. Patient-level data were identified from electronic medical record (EMR) such as age, gender, comorbid conditions, preoperative detail, antimicrobial prophylactic information, and postoperative results. The sample source was therefore the patients who underwent surgery in the participating health facilities and the main outcome for analysis was the number of SSIs that occurred within 30 days of the operation. Descriptive statistics, including median values expressed with interquartile ranges (IQR), chi-square tests of independence, and Fisher's exact logistic regression tests were used to compare SSIs with specific prophylaxis regimens.Results: Among the 632 donors, 362 (57.3%) were female and 270 (42.7%) were male. The median age was 35 years (IQR 30–42 years). 530 donors (83.9%) received a single preoperative antibiotic dose. The incidence of superficial SSIs was in 9 (1.4%) donors. Donors receiving multiple doses of antibiotics preoperatively had a higher likelihood of developing SSIs compared to those receiving a single dose (OR: 20.84, P-Value=0.001). Conversely, 625 donors positive for cytomegalovirus (CMV) (98.9%) were less likely to develop SSIs (OR: 0.07, P-Value=0.029).Conclusion: Minimizing preoperative antibiotic doses may reduce the risk of SSIs in kidney transplant donors. The study supports a "lesser is better" approach to antimicrobial prophylaxis, highlighting the need for further research on CMV's potential protective effect against SSIs.