Methicillin-resistant Staphylococcus aureus: the other emerging resistant gram-positive coccus among liver transplant recipients.
We undertook a study of the characteristics and clinical impact of infections due to methicillin-resistant Staphylococcus aureus (MRSA) after liver transplantation. Of 165 patients who received liver transplants at our institution from 1990 through 1998, 38 (23%) developed MRSA infections. The predominant sources of infection were vascular catheters (39%; n=15), wound (18%; n=7), abdomen (18%; n=7), and lung (13%; n=5). A significant increase in MRSA infections (as a percentage of transplant patients infected per year) occurred over time (P=.0001). This increase was greater among intensive care unit patients (P=.001) than among nonintensive care unit hospital patients (P=.17). Cytomegalovirus seronegativity (P=.01) and primary cytomegalovirus infection were significantly associated with MRSA infections (P=.005). Thirty-day mortality among patients with MRSA infections was 21% (8/38). Mortality was 86% in patients with bacteremic MRSA pneumonia or abdominal infection and 6% in those with catheter-related bacteremia (P=.004). Thus the incidence of MRSA infection has increased exponentially among our liver transplant recipients since 1990. These infections have unique risk factors, time of onset, and a significant difference in site-specific mortality; deep-seated bacteremic infections, in particular, portend a grave outcome.
Singh
N
N
Veterans Affairs Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA 15240, USA. nis5+@pitt.edu
Paterson
D L
DL
Chang
F Y
FY
Gayowski
T
T
Squier
C
C
Wagener
M M
MM
Marino
I R
IR
D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016017:Odds Ratio; D010414:Pennsylvania / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D018709:Statistics, Nonparametric; D015996:Survival Rate