Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy
Background. Although multifaceted control intervention actions (bundles) are highly effective in reducing the risk of device-related healthcare-associated infections (d-HAIs), no studies have explored their impact on the outcomes of kidney transplant recipients (KTRs) or the extent of risk reduction...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2025-02-01
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| Series: | Transplantation Direct |
| Online Access: | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001754 |
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| author | Maria Bethânia Peruzzo, MD Luana Oliveira Calegari, MSc Renato Demarchi Foresto, MD, PhD Helio Tedesco-Silva, MD, PhD José Medina Pestana, MD, PhD Lúcio Requião-Moura, MD, PhD |
| author_facet | Maria Bethânia Peruzzo, MD Luana Oliveira Calegari, MSc Renato Demarchi Foresto, MD, PhD Helio Tedesco-Silva, MD, PhD José Medina Pestana, MD, PhD Lúcio Requião-Moura, MD, PhD |
| author_sort | Maria Bethânia Peruzzo, MD |
| collection | DOAJ |
| description | Background. Although multifaceted control intervention actions (bundles) are highly effective in reducing the risk of device-related healthcare-associated infections (d-HAIs), no studies have explored their impact on the outcomes of kidney transplant recipients (KTRs) or the extent of risk reduction achievable through the bundle implementation.
Methods. Seven hundred ninety-eight prevalent KTRs admitted to the intensive care unit (ICU) requiring invasive devices were included: 449 patients from the bundle preimplementation period and 349 from the postimplementation period. The primary outcome was mortality within 90 d of ICU admission. Using Poisson regression models, the magnitude of risk reduction for d-HAIs after the bundle implementation and the impact of d-HAIs on the risk of death was estimated.
Results. The 90-d survival rate was significantly lower in patients with d-HAIs (37.7% versus 71.7%; P < 0.001). The bundle implementation reduced the risk of d-HAIs by 58% (relative risk, 0.42; P = 0.005). Despite the significant reduction in d-HAIs after the bundle implementation, d-HAIs were associated with a 2.6-fold higher risk of death (hazard ratio [HR], 2.63; P < 0.001) regardless of the study period. Additional variables associated with increased risk of death included age (HR, 1.03; P < 0.001), baseline immunosuppression (HR based on mycophenolate versus others 0.74; P = 0.02), time since transplantation (HR, 1.003; P < 0.001), platelet count at ICU admission (HR, 0.998; P < 0.001), and sepsis as the reason for ICU admission (HR, 1.67; P < 0.001).
Conclusions. The persistent risk associated with d-HAIs, despite the implementation of multifaceted control intervention actions in an ICU specialized in KTR care, underscores the need for a zero-tolerance policy toward d-HAIs. |
| format | Article |
| id | doaj-art-cc44970a84ca452e89c06c68828e823b |
| institution | Kabale University |
| issn | 2373-8731 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Transplantation Direct |
| spelling | doaj-art-cc44970a84ca452e89c06c68828e823b2025-01-24T09:21:00ZengWolters KluwerTransplantation Direct2373-87312025-02-01112e175410.1097/TXD.0000000000001754202502000-00004Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance PolicyMaria Bethânia Peruzzo, MD0Luana Oliveira Calegari, MSc1Renato Demarchi Foresto, MD, PhD2Helio Tedesco-Silva, MD, PhD3José Medina Pestana, MD, PhD4Lúcio Requião-Moura, MD, PhD51 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.1 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.1 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.1 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.1 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.1 Hospital do Rim, Fundação Oswaldo Ramos, São Paulo, Brazil.Background. Although multifaceted control intervention actions (bundles) are highly effective in reducing the risk of device-related healthcare-associated infections (d-HAIs), no studies have explored their impact on the outcomes of kidney transplant recipients (KTRs) or the extent of risk reduction achievable through the bundle implementation. Methods. Seven hundred ninety-eight prevalent KTRs admitted to the intensive care unit (ICU) requiring invasive devices were included: 449 patients from the bundle preimplementation period and 349 from the postimplementation period. The primary outcome was mortality within 90 d of ICU admission. Using Poisson regression models, the magnitude of risk reduction for d-HAIs after the bundle implementation and the impact of d-HAIs on the risk of death was estimated. Results. The 90-d survival rate was significantly lower in patients with d-HAIs (37.7% versus 71.7%; P < 0.001). The bundle implementation reduced the risk of d-HAIs by 58% (relative risk, 0.42; P = 0.005). Despite the significant reduction in d-HAIs after the bundle implementation, d-HAIs were associated with a 2.6-fold higher risk of death (hazard ratio [HR], 2.63; P < 0.001) regardless of the study period. Additional variables associated with increased risk of death included age (HR, 1.03; P < 0.001), baseline immunosuppression (HR based on mycophenolate versus others 0.74; P = 0.02), time since transplantation (HR, 1.003; P < 0.001), platelet count at ICU admission (HR, 0.998; P < 0.001), and sepsis as the reason for ICU admission (HR, 1.67; P < 0.001). Conclusions. The persistent risk associated with d-HAIs, despite the implementation of multifaceted control intervention actions in an ICU specialized in KTR care, underscores the need for a zero-tolerance policy toward d-HAIs.http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001754 |
| spellingShingle | Maria Bethânia Peruzzo, MD Luana Oliveira Calegari, MSc Renato Demarchi Foresto, MD, PhD Helio Tedesco-Silva, MD, PhD José Medina Pestana, MD, PhD Lúcio Requião-Moura, MD, PhD Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy Transplantation Direct |
| title | Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy |
| title_full | Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy |
| title_fullStr | Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy |
| title_full_unstemmed | Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy |
| title_short | Persistent Mortality Risk From Device-related Healthcare-associated Infection in Kidney Transplant Recipients Despite Multifaceted Interventions Action Calls for a Zero-tolerance Policy |
| title_sort | persistent mortality risk from device related healthcare associated infection in kidney transplant recipients despite multifaceted interventions action calls for a zero tolerance policy |
| url | http://journals.lww.com/transplantationdirect/fulltext/10.1097/TXD.0000000000001754 |
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