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- Title
Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study.
- Authors
Gearhart, Michelle; Martin, Jill; Rudich, Steve; Thomas, Mark; Wetzel, Dave; Solomkin, Joseph; Hanaway, Michael J.; Aranda-Michel, Jaime; Weber, Fred; Trumball, Leslie; Bass, Maryetta; Zavala, Ed; Steve Woodle, E.; Buell, Joseph F.
- Abstract
Background: Liver transplant recipients are at high risk for multi-drug resistant infections because of broad-spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients. Methods: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co-infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls. Results: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty-eight non-VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4–348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non-VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group ($6500 vs. 1750; p = 0.02) as well. Conclusion: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non-VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.
- Subjects
LIVER transplantation; ANTIBIOTICS; LIVER diseases; VANCOMYCIN; ANTIBACTERIAL agents
- Publication
Clinical Transplantation, 2005, Vol 19, Issue 6, p711
- ISSN
0902-0063
- Publication type
Article
- DOI
10.1111/j.1399-0012.2005.00362.x