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ORIGINAL RESEARCH article

Front. Med.

Sec. Nephrology

Volume 12 - 2025 | doi: 10.3389/fmed.2025.1665151

This article is part of the Research TopicExploring infectious diseases in kidney transplantation: From molecular mechanisms to clinical outcomesView all articles

Preemptive Antibiotic Strategies for Gram-Positive Bacteria in Preservation Fluid: A Single-Center Experience

Provisionally accepted
Jianming LiJianming Li1Jianyi LiJianyi Li2Jun LiJun Li1Qian FuQian Fu1Chenglin WuChenglin Wu1Huanxi ZhangHuanxi Zhang1Xiaojun SuXiaojun Su1*Longshan LiuLongshan Liu3*Changxi WangChangxi Wang1
  • 1Sun Yat-sen University First Affiliated Hospital Organ Transplantation Department, Guangzhou, China
  • 2Shandong Provincial Qianfoshan Hospital, Jinan, China
  • 3Organ Transplantation Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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Objective: To elucidate the risk stratification of Gram-positive bacteria in the preservation fluid (PF), investigate antibiotic resistance and its role in early post-kidney transplant infections, and assess the efficacy of preemptive-anti-Gram-positive antibiotic(P-antiGP) therapy. Methods: This retrospective study analyzed the clinical data of 144 kidney transplant donors and 218 recipients between April 2015 to October 2020. Recipients with any of the high-virulence Gram-positive bacteria (such as Enterococcus faecium, Enterococcus faecalis, and Staphylococcus aureus) in PF were defined as high-risk group. Recipients with other pathogens in PF were defined as low-risk group. Results: The high-risk group had a significantly higher incidence of infection events as compared with the low-risk group (42.6 % vs 26.2 %, P = 0.014). Multivariate analysis indicated a trend toward an increased risk of early post-transplant infections in the high-risk group (adjusted OR = 1.855, 95% CI: 0.991–3.464, P = 0.052). Seven recipients (1.5 %) were diagnosed as possible donor-derived infections (P-DDIs) and all of them were from the high-risk group. 56.4% (123/218) of recipients had multidrug-resistant organisms (MDROs) in PF and 12.4% (27/218) had extensively-resistant organisms (XDROs). The P-DDIs rate was notably higher in the extensively drug-resistant (XDR) group than non-XDR group (11.1% vs 2.1%, P=0.014). The incidence of P-DDIs was significantly lower (P = 0.025) in recipients with P-antiGP therapy (4.3 %) as compared to recipients who did not (23.8 %). Conclusion: E. faecium, E. faecalis, and S. aureus in PF are considered high-virulence Gram-positive bacteria, and recipients with these pathogens are categorized as high-risk group. Additionally, a high prevalence of antibiotic resistance exists among Gram-positive bacteria in PF, correlating with post-transplant infections. Furthermore, The addition of P-antiGP therapy as a preemptive therapy in the high-risk group can effectively reduce the incidence of P-DDIs.

Keywords: preemptive-anti-Gram-positive antibiotic therapy, preservation fluid, Infection, Gram-Positive Bacteria, Kidney transplant

Received: 13 Jul 2025; Accepted: 19 Aug 2025.

Copyright: © 2025 Li, Li, Li, Fu, Wu, Zhang, Su, Liu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Xiaojun Su, Sun Yat-sen University First Affiliated Hospital Organ Transplantation Department, Guangzhou, China
Longshan Liu, Organ Transplantation Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

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