Implementation of a Protocol With a Shortened Vancomycin Prophylaxis Duration is Associated With Reduced Acute Kidney Injury in Lung Transplant Recipients: A Quasi-Experimental Study.

Background: Vancomycin plus an antipseudomonal β-lactam are common antibiotics used for lung transplant surgical prophylaxis, but the optimal post-operative duration is unknown. The study objective was to assess the impact of a shortened antibacterial surgical prophylaxis duration on post-operative acute kidney injury (AKI) in lung transplant recipients.

Methods: This was an IRB approved, single pre-/post-test quasi-experiment of lung transplant recipients who received post-operative antibiotic prophylaxis from January 1, 2016-September 30, 2020 (pre-group) to October 1, 2020-March 31, 2025 (post-group). The intervention included modifying vancomycin (and cefepime) post-operative prophylaxis durations to 72 h; the previous prophylaxis standard included continuing vancomycin until chest tube removal. The primary endpoint was incidence of AKI, defined by the KDIGO criteria, while receiving post-operative vancomycin up to 14 days. Thirty-day secondary outcomes included surgical site infection (SSI), treatment of lower respiratory-tract infection, and isolation of multi-drug-resistant organisms (MDRO).

Results: Ninety patients were included-45 pre- and 45 post-intervention. Most patients were men (64.4%) and had a median (IQR) age of 63 (58-68) years. The most common indication for transplant was pulmonary fibrosis (37.8%). The incidence of 14-day AKI was reduced when comparing pre- and post-intervention groups (48.9% vs. 28.9%, p = 0.052), with no differences in SSI (2.2% vs. 2.2%, p = 1.0), treatment of lower respiratory tract infection (57.8% vs. 73.3%, p = 0.120), and isolation of MDRO (15.6% vs. 13.3%, p = 0.764). When accounting for baseline renal function, patients in the post-intervention group had a significantly decreased odds of AKI (adjOR, 0.385; 95%CI, 0.154-0.959).

Conclusion: Implementation of a shortened post-operative vancomycin prophylaxis duration protocol was associated with reduced odds of AKI in lung transplant recipients, with similar post-operative infectious complications.