Fatores de Risco para Infecções em Transplante Renal

Abstract

Objectives: To investigate the prevalence of nosocomial infections (NIs) occurring up to 30 days following renal transplant at the Hospital Santa Casa de Misericórdia in Goiânia and to analyze risk factors for the development of surgical site infection (SSI) in renal transplant recipients and the consequences of the infections. Methods: A retrospective study was performed from January 2004 to June 2006, which determined hospital infections occurring during the first 30 days following renal transplant and the risk factors for the development of SSI and its consequences. A form was designed as an instrument for data collection containing the patients clinical and demographic information from hospital admission to discharge. Result: 108 renal transplants were analyzed, 49 (45.4%) of which were performed in female patients and 59 (54.6%) in male patients. Grafts from live donors totaled 67 (62%) and constituted the majority. Grafts from deceased donors totaled 41 (38%). The mean age was 38.1 years old and the average time of hospital stay was 16 days. The incident rate of bacterial nosocomial infection (NI) in recipients was 35.18% and occurred in 28 (25.9%) patients. Nine of the recipients presented two or more episodes of infection during the time of hospital stay. In this review, 38 episodes of bacterial nosocomial infection were diagnosed, 20 (18.5%) cases of urinary tract infection (UTI), 9 (8.33%) cases of SSI, 3 (2.77%) cases of pneumonias, 5 (4.62%) cases of bloodstream infection (septicemia) and 1 (0.92%) case of other infections. During the first 30 days, no loss of graft or death was observed. The number of infection episodes was directly proportional to the increase in the average and the median time of hospital stay (p< 0.001). UTI was the most prevalent and recipients of grafts from deceased donors were more prone to developing UTI than were recipients receiving grafts from live donors; in addition, the former group had twice as many more chances of developing UTI (p<0.046; OR=2.363). Fifty-four (50%) recipients presented graft dysfunction, thirteen of whom reestablished renal function without the need for dialytic treatment and 41 (38%) of whom underwent it through hemodialysis in the absolute majority of cases. Organs from deceased donors were more susceptible to the occurrence of graft dysfunction (p=0.001), in a ratio almost twenty times higher (OR=19.600). In the multivariate analysis, the following were regarded as risk factors for the development of SSI: time of pre-transplant dialytic treatment, presence of graft dysfunction, need for post-transplant dialytic treatment and number in units in the use of hemoderivatives. Conclusions: The low levels of effective organ donation accounted for a smaller number of grafts from deceased donors during the study. Bacterial nosocomial infections (NI) increased the time of hospital stay. The time of duration of dialysis treatment, graft dysfunction, the need for post-transplant dialytic treatment and an increase in the volume of associated hemoderived infusion represented higher risk of SSI. Graft dysfunction was higher in corpse donors. UTI was the most prevalent, which was regarded as risk for the development of SSI. Recipients of grafts from corpse donors were more susceptible to UTI. Re-operations, urological complications and hematomas of operative wound predisposed to SSI.