Epidemiology and clinical consequences of vancomycin-resistant enterococciin liver transplant patients

Background. Vancomycin-resistant enterococci (VRE) are increasingly importa nt as pathogens in liver transplant patients. To guide control efforts, we conducted an epidemiological study of the frequency, source, and modes of t ransmission of VRE at our center. Methods. During September 1998 through August 1999, we obtained weekly surv eillance cultures from consenting liver transplant patients and surfaces in their rooms. Pooled handwash specimens from personnel also were obtained. Specimens were processed on selective media to detect VRE, and isolates wer e typed by pulsed field gel electrophoresis. Information was collected from patient records concerning in-hospital treatment and clinical course. Results. Serial cultures were obtained during 33 admissions of 29 patients. VRE were detected in initial specimens from 6 admissions, and nosocomial a cquisition of VRE occurred in 12 (44%) of the remaining 27 admissions. Seve n different strain types of VRE were detected. The initial site of acquisit ion was stool in all cases; bile became culture-positive in only two patien ts. Overall, 16 (55%) of the 29 patients became colonized, usually after tr ansplantation. VRE were detected in environmental cultures during 10 admiss ions and in 2 of 21 pooled handwashes. No statistically significant differe nces in clinical status or treatment were found when colonized patients wer e compared to noncolonized controls. The only VRE infection resulted from a choledochojejunostomy anastomotic leak. Conclusion. Alimentary tract colonization by VRE occurred commonly in liver transplant patients, probably by cross-transmission. The clinical conseque nces were modest in the patients studied, but colonized transplant patients provide a substantial reservoir for continued VRE transmission in hospital s.