INCIDENCE AND OUTCOME OF INFECTION BY VANCOMYCIN-RESISTANT ENTEROCOCCUS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Vancomycin resistant Enterococcus (VRE) has become a significant nosoc omial pathogen, For this study, the records of 325 patients who underw ent 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 infe ctions with VRE included previous antibiotic use (25 patients, 15 of w hom received vancomycin), co-infection by other pathogens (28 patients ), and relaparotomy following OLT (20 patients). Pulmonary and/or rena l failure preceded infection by VRE in 11 and 4 adult patients, respec tively. Biliary complications were exceedingly common in patients infe cted by VRE (28 patients) and significantly increased the risk of infe ction by VRE (21.5% vs, 3.1% for patients without biliary complication s, P<0.0001). Mortality associated with VRE infections was high (56% v s. 19% for patients not infected by VRE, P<0.0005), The most frequent cause of death was sepsis (16 of 19 patient deaths), often polymicrobi al, 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 fac tors associated with VRE infection, We suggest early surgical interven tion to treat complications that may predispose patients to infection by VRE.