We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
A single-center experience with infections due to daptomycin-nonsusceptible Enterococcus faecium in liver transplant recipients.
- Authors
Lewis, J.D.; Enfield, K.B.; Cox, H.L.; Mathers, A.J.; Sifri, C.D.
- Abstract
Background Infections caused by vancomycin-resistant Enterococcus faecium ( VRE) are a major cause of morbidity and mortality in the liver transplant population. Daptomycin ( DAP) is often used to treat infections caused by VRE, but DAP nonsusceptibility in Enterococcus is increasing. Method Patients with DAP-nonsusceptible Enterococcus ( DNSE) infections who had undergone liver transplantation between January 1, 2010 and July 31, 2014 were retrospectively reviewed. A convenience sample of DNSE isolates was analyzed by pulsed-field gel electrophoresis ( PFGE). Results We identified 14 liver transplant recipients ( LTRs) who developed DNSE infections post transplantation. Postoperative complications were common, and most patients required repeat abdominal surgery within 90 days of transplantation. The initial DNSE culture was taken a median of 74.5 days post transplant and was secondary to an intra-abdominal infection in all but 1 patient. Half of patients were VRE colonized before or at the time of organ transplantation, and all those who were not VRE colonized at the time of transplantation later became colonized, a median of 27 days post transplant. Overall mortality in this cohort was 71%. PFGE did not demonstrate genetic relatedness among DNSE isolates. Conclusion This study, the largest published series to our knowledge of DNSE infections in LTRs, demonstrates that these infections occur in patients with serious surgical complications and are associated with high morbidity and mortality. Established risk factors for VRE infection were common, as was DAP exposure. Although many risk factors for DNSE infection cannot be changed, this case series identifies several potentially modifiable variables. Further work is needed to identify interventions to decrease the risk of developing DNSE infections in this complex patient population.
- Subjects
ENTEROCOCCUS faecium; LIVER transplantation; VANCOMYCIN; PULSED-field gel electrophoresis; ORGAN donors
- Publication
Transplant Infectious Disease, 2016, Vol 18, Issue 3, p341
- ISSN
1398-2273
- Publication type
Article
- DOI
10.1111/tid.12523