Abstract：
BACKGROUND: Infection 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.
METHODS: A 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.
RESULTS: The 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.
CONCLUSIONS: A 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.
METHODS: A 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.
RESULTS: The 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.
CONCLUSIONS: A 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.
摘要：
背景：感染仍然是肾移植（KT）后的相关并发症。现代医学中公认的策略是在临床环境中应用大量循证实践。这项研究的目的是探索个性化的捆绑措施的应用，旨在减少KT后的前12个月感染的发生率。
方法：将2018年2月至2019年9月接受KT的148例接受个体化感染预防策略的单中心前瞻性队列与干预前队列进行比较（n=159）。捆绑包包括对患者免疫史的回顾，按原籍国划分的感染风险，潜伏性结核感染（LTBI）筛查，抗菌预防，和免疫学评估。因此,在移植后第+30天的预定访视时提供个性化建议。
结果：干预队列显示对推荐疫苗方案的依从率较高，筛查地理限制感染和LTBI，以及静脉注射免疫球蛋白和维生素D补充剂（p值<.001）。干预队列中1年感染率较低(42.6%vs.57.9%；p值=.037)，与感染相关的住院率(17.6%vs.32.1%；p值=.003）和严重细菌感染的发生率。两组之间的移植物排斥反应或死亡率没有差异。
结论：多方面干预，包括一系列基于证据的做法，提高了对推荐预防措施的依从性,并与KT后12个月感染率的降低相关.
方法：将2018年2月至2019年9月接受KT的148例接受个体化感染预防策略的单中心前瞻性队列与干预前队列进行比较（n=159）。捆绑包包括对患者免疫史的回顾，按原籍国划分的感染风险，潜伏性结核感染（LTBI）筛查，抗菌预防，和免疫学评估。因此,在移植后第+30天的预定访视时提供个性化建议。
结果：干预队列显示对推荐疫苗方案的依从率较高，筛查地理限制感染和LTBI，以及静脉注射免疫球蛋白和维生素D补充剂（p值<.001）。干预队列中1年感染率较低(42.6%vs.57.9%；p值=.037)，与感染相关的住院率(17.6%vs.32.1%；p值=.003）和严重细菌感染的发生率。两组之间的移植物排斥反应或死亡率没有差异。
结论：多方面干预，包括一系列基于证据的做法，提高了对推荐预防措施的依从性,并与KT后12个月感染率的降低相关.
