Novel intervention based on an individualized bundle of care to decrease infection in kidney transplant recipients

Abstract

AbstractBackgroundInfection remains a relevant complication after kidney transplantation (KT). A well‐established strategy in modern medicine is the application of bundles of evidence‐based practice in clinical settings. The objective of this study is to explore the application of a personalized bundle of measures aimed to reduce the incidence of infection in the first 12 months after KT.MethodsA single‐center prospective cohort of 148 patients undergoing KT between February 2018 and September 2019 that received an individualized infection prevention strategy was compared to a preintervention cohort (n = 159). The bundle comprised a review of the patient's immunization history, infection risk by country of origin, screening for latent tuberculosis infection (LTBI), antimicrobial prophylaxis, and immunological assessment. Individualized recommendations were accordingly provided at a scheduled visit at day +30 after transplantation.ResultsThe intervention cohort showed a higher compliance rate with the recommended vaccine schedule, screening for geographically restricted infections and LTBI, and intravenous immunoglobulin and vitamin D supplementation (p values <.001). The 1‐year incidence rate of infection was lower in the intervention cohort (42.6% vs. 57.9%; p value = .037), as was the rate of infection‐related hospitalization (17.6% vs. 32.1%; p value = .003) and the incidence of severe bacterial infection. There were no differences in graft rejection or mortality rates between groups.ConclusionsA multifaceted intervention, including a bundle of evidence‐based practices, enhanced compliance with recommended preventive measures and was correlated with a reduction in the 12‐month incidence of infection after KT. image