title: Incidence and outcome of infection by vancomycin-resistant Enterococcus following orthotopic liver transplantation.
abstract: Vancomycin-resistant Enterococcus (VRE) has become a significant nosocomial pathogen. For this study, the records of 325 patients who underwent orthotopic liver transplantation (OLT) were reviewed. Thirty-four patients were infected by VRE (incidence of 10.5%, 14% in adults vs. 5% in children, P < 0.01). Common features of patients who developed infections with VRE included previous antibiotic use (25 patients, 15 of whom received vancomycin), co-infection by other pathogens (28 patients), and relaparotomy following OLT (20 patients). Pulmonary and/or renal failure preceded infection by VRE in 11 and 4 adult patients, respectively. Biliary complications were exceedingly common in patients infected by VRE (28 patients) and significantly increased the risk of infection by VRE (21.5% vs. 3.1% for patients without biliary complications, P < 0.0001). Mortality associated with VRE infections was high (56% vs. 19% for patients not infected by VRE, P < 0.0005). The most frequent cause of death was sepsis (16 of 19 patient deaths), often polymicrobial. The high incidence of infection by VRE following OLT, the lack of effective antibiotics for the treatment of VRE, and the association of VRE with patient mortality emphasizes the need to define the risk factors associated with VRE infection. We suggest early surgical intervention to treat complications that may predispose patients to infection by VRE.
authors.affiliation: Department of Surgery, University of Chicago, Illinois 60637, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: Newell
authors.forename: J M
authors.initials: JM
authors.lastname: Millis
authors.forename: P M
authors.initials: PM
authors.lastname: Arnow
authors.forename: D S
authors.initials: DS
authors.lastname: Bruce
authors.forename: E S
authors.initials: ES
authors.lastname: Woodle
authors.forename: D C
authors.initials: DC
authors.lastname: Cronin
authors.forename: G E
authors.initials: GE
authors.lastname: Loss
authors.forename: H
authors.initials: H
authors.lastname: Grewal
authors.forename: T
authors.initials: T
authors.lastname: Lissoos
authors.forename: T
authors.initials: T
authors.lastname: Schiano
authors.forename: J
authors.initials: J
authors.lastname: Mead
authors.forename: J R
authors.initials: JR
authors.lastname: Thistlethwaite
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology / Q000401:mortality; D002648:Child; D004352:Drug Resistance, Microbial; D016983:Enterococcus; D005705:Gallbladder Diseases / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D051437:Renal Insufficiency / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin