Vancomycin-resistant Enterococcus in liver transplant patients

BACKGROUND: Vancomycin-resistant Enterococcus (VRE) infection is emerging i n the transplant population, and there is no effective antibiotic therapy a vailable. The aims of this retrospective review were to (1) investigate the outcome of and (2) identify common characteristics associated with VRE inf ection and colonization in orthotopic liver transplant (OLTx) candidates. METHODS: From October 1994 through September 1998, 126 isolates of VRE were identified in 42 of 234 OLTx recipients and 5 OLTx candidates who did not proceed to transplantation. Data were collected by patient chart review or from a computerized hospital database, RESULTS: The 1-year mortality rate with VRE infection was 82%, and with VRE colonization, 7%, This mortality rate contrasts with a 14% 1-year mortalit y for non-VRE transplant patients (P <0.01, infected patients and colonized patients). Characteristics of VRE colonized and infected patients included recent prior vancomycin (87%), coinfection by other microbial pathogens (7 4%), recent prior susceptible enterococcal infection (72%), concurrent fung al infection (62%), additional post-OLTx laparotomies (47%), and renal fail ure (Cr >2.5 mg/dL or need for dialysis; 43%), Biliary complications were s een in 52% of post-OLTx VRE-infected or VRE-colonized patients (versus 22% in non-VRE transplant patients, P <0.05). CONCLUSION: VRE infection is associated with a very high mortality rate aft er liver transplantation, The incidence of biliary complications prior to V RE isolation is very high in VRE-infected and VRE-colonized patients, The m ost common characteristics of VRE patients were recent prior vancomycin use , recent prior susceptible enterococcal infection, coinfection with other m icrobial pathogens, and concurrent fungal infection. With no proven effecti ve antimicrobial therapy for VRE, stringent infection control measures, inc luding strict and limited use of vancomycin, must be practiced. Am J Surg. 1999;177:418-422, (C) 1999 by Excerpta Medica, Inc.