M. Bakir et al., Epidemiology and clinical consequences of vancomycin-resistant enterococciin liver transplant patients, TRANSPLANT, 72(6), 2001, pp. 1032-1037
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.