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      Surgical Site Infections Complicating the Use of Negative Pressure Wound Therapy in Renal Transplant Recipients

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          Abstract

          Surgical site infections (SSI) of the abdominal wall in renal transplant recipients can on occasion require management with negative pressure wound therapy (NPWT). This is often successful, with a low risk of further complications. However, we describe three cases in which persistent or recurrent surgical site sepsis occurred, whilst NPWT was being deployed in adults with either wound dehiscence or initial SSI. This type of complication in the setting of NPWT has not been previously described in renal transplant recipients. Our case series demonstrates that in immunosuppressed transplant recipients, there may be ineffective microbial or bacterial bioburden clearance associated with the NPWT, which can lead to further infections. Hence recognition for infections in renal transplant patients undergoing treatment with NPWT is vital; furthermore, aggressive management of sepsis control with early debridement, antimicrobial use, and reassessment of the use of wound dressing is necessary to reduce the morbidity associated with surgical site infections and NPWT.

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          Most cited references40

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          Vacuum-Assisted Closure: A New Method for Wound Control and Treatment

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            Negative pressure wound therapy after severe open fractures: a prospective randomized study.

            To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection. Prospective randomized study. Academic level I trauma center. Fifty-nine patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures. Twenty-three patients with 25 fractures randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing, with repeat irrigation and debridement every 48-72 hours until wound closure. Thirty-five patients randomized to the NPWT group and had identical treatment except that NPWT was applied to the wounds between irrigation and debridement procedures until closure. The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures. Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%). There is a significant difference between the groups for total infections (P = 0.024). The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group. NPWT represents a promising new therapy for severe open fractures after high-energy trauma.
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              Obesity, surgical site infection, and outcome following renal transplantation.

              We sought to understand whether obesity imparts detriment in outcome beyond risk of developing surgical site infection (SSI). Obesity is a risk factor for SSI following renal transplantation, and has been implicated in inferior patient and graft survival postoperatively. We conducted a retrospective review of all adult kidney-only transplants performed at the University of Michigan between September 2003 and April 2008. The primary exposure variable was recipient body mass index (BMI). Cox multivariable regression and Kaplan-Meier analysis were used to identify factors associated with SSI, graft loss, and patient death. In total, 869 recipients were studied, including 351 with BMI >30. Multivariate analysis revealed recipient age, delayed graft function, and BMI >30 to be independent risk factors for SSI. SSI was a significant risk factor for graft loss (HR: 2.194, 95% CI: 1.357-3.546) and approached significance as a risk factor for patient death (HR: 1.689, 95% CI: 0.941-3.028). Obesity had no independent effect on graft or patient outcome. SSI is associated with detriment to patient and graft survival following renal transplantation. The prevalence of SSI is higher among obese recipients, but those who avoid SSI have comparable outcomes to nonobese recipients. These findings redemonstrate the importance of SSI prevention following renal transplantation.
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                Author and article information

                Contributors
                Journal
                Case Rep Transplant
                Case Rep Transplant
                CRIT
                Case Reports in Transplantation
                Hindawi
                2090-6943
                2090-6951
                2019
                24 September 2019
                : 2019
                : 2452857
                Affiliations
                1Royal Prince Alfred Hospital, Department of Transplantation Services, Sydney, Australia
                2The University of Sydney, Faculty of Medicine and Health, Edward Ford Building, Fisher Road, NSW 2006, Australia
                Author notes

                Academic Editor: Frieder Keller

                Author information
                https://orcid.org/0000-0002-2231-660X
                Article
                10.1155/2019/2452857
                6778947
                2233ee37-4ed8-4c92-9106-04eb748dd833
                Copyright © 2019 Susanna Lam et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 5 April 2019
                : 29 May 2019
                : 30 July 2019
                Categories
                Case Report

                Transplantation
                Transplantation

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