RELEVANCE AND RISK-FACTORS OF ENTEROCOCCAL BACTEREMIA FOLLOWING LIVER-TRANSPLANTATION

To analyze the clinical characteristics of and identify specific risk factors for enterococcal bacteremia following liver transplantation, i ve performed a study in 405 consecutive Liver transplantation recipien ts 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 complica tions were present in 34% of enterococcal bacteremias. Of the 15 death s (29%) among the patients with enterococcal bacteremia, 4 were direct ly associated with enterococcal bacteremia. In a multivariate analysis , Roux-en-Y choledochojejunostomy (P=0.005), a cytomegalovirus-seropos itive donor (P=0.013), prolonged transplantation time (P=0.02), and bi liary stricturing (P=0.016) were identified as significant risk factor s. Other risk factors identified in a univariate analysis included pri mary 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 b owel decontamination. Its association with cytomegalovirus and biliary tree abnormalities suggest specific areas for prophylactic interventi on.