title: Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of sepsis in patients with cirrhosis and after liver transplantation. The association between nasal carriage of MRSA and sepsis in these patients is unclear. The goal of this study was to investigate the relationship between MRSA carriage before liver transplantation and subsequent sepsis after transplantation. This was a retrospective study of 374 consecutive adults who underwent orthotopic liver transplantation between 1998 and 2001 and for whom full data were available. Of these, 157 had been screened for MRSA as part of a study assessing the prevalence of MRSA infection. All MRSA carriers were treated with nasal mupirocin and chlorhexidine baths. The records of MRSA carriers and noncarriers were analyzed for Child and Model for End-Stage Liver Disease (MELD) score, posttransplantation MRSA, and other infections and mortality. Of the 157 patients who had an MRSA screen, 35 patients were MRSA nasal carriers. These carriers had significantly greater MELD score (mean, 16.2 compared with 13.1; P =.02) and Child scores (mean, 10 versus 9; P =.001) than noncarriers. The incidence of posttransplantation MRSA infection was significantly higher in MRSA carriers (31% versus 9%; P =.002). The incidence of other posttransplantation infection was not significantly different in the two groups. There was no significant difference in survival between the two groups (1-year patient survival, 74% and 82%, respectively). Patients carrying MRSA are predisposed to an increased risk of sepsis after liver transplantation with a trend to increased mortality. Screening for MRSA should be considered in high-risk patients being assessed for liver transplantation.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Devendra
authors.initials: D
authors.lastname: Desai
authors.forename: Nutan
authors.initials: N
authors.lastname: Desai
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Tom
authors.initials: T
authors.lastname: Elliott
authors.forename: James
authors.initials: J
authors.lastname: Neuberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects; D016896:Treatment Outcome