title: Relevance and risk factors of enterococcal bacteremia following liver transplantation.
abstract: To analyze the clinical characteristics of and identify specific risk factors for enterococcal bacteremia following liver transplantation, we performed a study in 405 consecutive liver transplantation recipients prophylaxed with a selective bowel decontamination regimen. Seventy enterococcal bacteremias in 52 patients were identified. Enterococcus faecalis (50) outnumbered Enterococcus faecium isolates (18), and 49% of enterococcal bacteremias were polymicrobial. Biliary tree complications were present in 34% of enterococcal bacteremias. Of the 15 deaths (29%) among the patients with enterococcal bacteremia, 4 were directly associated with enterococcal bacteremia. In a multivariate analysis, Roux-en-Y choledochojejunostomy (P=0.005), a cytomegalovirus-seropositive donor (P=0.013), prolonged transplantation time (P=0.02), and biliary stricturing (P=0.016) were identified as significant risk factors. Other risk factors identified in a univariate analysis included primary sclerosing cholangitis (P=0.009) and symptomatic cytomegalovirus infection (P=0.008). Enterococcal bacteremia is a frequent infectious complication in liver transplantation recipients receiving selective bowel decontamination. Its association with cytomegalovirus and biliary tree abnormalities suggest specific areas for prophylactic intervention.
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: R
authors.initials: R
authors.lastname: Patel
authors.forename: A D
authors.initials: AD
authors.lastname: Badley
authors.forename: J
authors.initials: J
authors.lastname: Larson-Keller
authors.forename: W S
authors.initials: WS
authors.lastname: Harmsen
authors.forename: D M
authors.initials: DM
authors.lastname: Ilstrup
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: J L
authors.initials: JL
authors.lastname: Steers
authors.forename: R A
authors.initials: RA
authors.lastname: Krom
authors.forename: D
authors.initials: D
authors.lastname: Portela
authors.forename: F R
authors.initials: FR
authors.lastname: Cockerill
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
mesh_terms: D000713:Anastomosis, Roux-en-Y; D016470:Bacteremia / Q000209:etiology; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D016908:Gram-Positive Bacterial Infections / Q000209:etiology*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D012307:Risk Factors