Kidney Transplant Antibiotic Prophylaxis (896)

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations

Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.

If >1.5L blood loss: replace fluid and repeat antibiotic dose intra-operatively: co-amoxiclav, flucloxacillin. Amikacin should be re-dosed at half prophylaxis dose. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.

If surgery prolonged >4hrs post first antibiotic dose: repeat co-amoxiclav, flucloxacillin, >8hrs post first antibiotic dose – repeat co-amoxiclav, flucloxacillin, and if eGFR > 60mls/min/ 1.73m2 amikacin (full prophylactic dose). No repeat dosing of teicoplanin if surgery prolonged.

MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.

CPE carriers: For those patients who have been identified as CPE (carbapenemase producing enterobacteriaceae) carriers, contact microbiology.

Teicoplanin#

Give 400mg teicoplanin by slow intravenous injection over 3-5 minutes
Teicoplanin and amikacin are incompatible when mixed directly and must not be mixed before injection.

Weight > 100 Kg

Increase the dose of co-amoxiclav as below:

Antibiotic	Procedure
Co-amoxiclav	> 100 Kg add 1g IV amoxicillin to 1.2g IV co-amoxiclav

Table: Procedure > Antibiotic

Procedure	Recommended Antibiotic Regimen	Comments
Renal Transplant	IV Co-amoxiclav 1.2g or If true penicillin/ beta-lactam allergy or MRSA risk: IV Teicoplanin^#400mg Plus IV Amikacin (see Amikacin Dosing Guide)	Review recent microbiology and MSU results and discuss with microbiology. Amikacin can be given as a slow IV bolus over 2-3 minutes. Amikacin has a low pH and may cause venous irritation and tissue damage in cases of extravasation
Nephrectomy – Transplant Not infected Early or Late Explant	IV Flucloxacillin 1g Or If true penicillin/ beta-lactam allergy or MRSA risk: IV Teicoplanin^#400 mg
Nephrectomy – Transplant Infected	Peri-operative antibiotics should be determined on an individual patient basis. Discuss with microbiology prior to surgery
Donor Nephrectomy for Transplant	IV Flucloxacillin 1g Or If true penicillin/ beta-lactam allergy or MRSA risk: IV Teicoplanin^#400mg