N. Singh et al., Methicillin-resistant Staphylococcus aureus: The other emerging resistant gram-positive coccus among liver transplant recipients, CLIN INF D, 30(2), 2000, pp. 322-327
We undertook a study of the characteristics and clinical impact of infectio
ns due to methicillin-resistant Staphylococcus aureus (MRSA) after liver tr
ansplantation. Of 165 patients who received liver transplants at our instit
ution from 1990 through 1998, 38 (23%) developed MRSA infections. The predo
minant sources of infection were vascular catheters (39%; n = 15), wound (1
89 ; n = 7), abdomen (18%; n = 7), and lung C13%; n = 5), A significant inc
rease in MRSA infections las a percentage of transplant patients infected p
er year) occurred over time (P = .0001), This increase was greater among in
tensive care unit patients (P = .001) than among nonintensive care unit hos
pital patients CP = .17). Cytomegalovirus seronegativity (P = .01) and prim
ary cytomegalovirus infection were significantly associated with MRSA infec
tions (P = .005). Thirty-day mortality among patients with MRSA infections
was 21% (8/38). Mortality was 86% in patients with bacteremic MRSA pneumoni
a or abdominal infection and 6% in those with catheter-related bacteremia (
P = .004). Thus the incidence of MRSA infection has increased exponentially
among our liver transplant recipients since 1990. These infections have un
ique risk factors, time of onset, and a significant difference in site-spec
ific mortality; deep-seated bacteremic infections, in particular, portend a
grave outcome.