Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study.
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 dollars vs. 1750; p = 0.02) as well.


CONCLUSIONS
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.
Gearhart
Michelle
M
The Division of Transplantation, The University of Cincinnati, Cincinnati, OH, USA.
Martin
Jill
J
Rudich
Steve
S
Thomas
Mark
M
Wetzel
Dave
D
Solomkin
Joseph
J
Hanaway
Michael J
MJ
Aranda-Michel
Jaime
J
Weber
Fred
F
Trumball
Leslie
L
Bass
Maryetta
M
Zavala
Ed
E
Steve Woodle
E
E
Buell
Joseph F
JF
D016983:Enterococcus / Q000187:drug effects; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008099:Liver / Q000382:microbiology*; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020713:Vancomycin Resistance