Related Experiment Video
Updated: Aug 4, 2026
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
A randomized trial of surgical antimicrobial prophylaxis with and without vancomycin in organ transplant patients
J Pfundstein1, M C Roghmann, R S Schwalbe
1Department of Medicine, University of Maryland School of Medicine, Baltimore, USA.
Background:
Gram-positive organisms, including vancomycin-resistant enterococci (VRE), have emerged as major pathogens on the organ transplant service at our institution. We hypothesized that our use of vancomycin as part of routine surgical prophylaxis increased the risk of VRE colonization and infection; conversely, there was concern that failure to use vancomycin prophylaxis would increase peri-operative morbidity due to gram-positive organisms.
Methods:
Renal transplant recipients (n = 88) were randomized to receive either a) vancomycin/ceftriaxone or b) cefazolin; and pancreas transplants (n = 24) to receive either a) vancomycin/gentamicin or b) cefazolin/gentamicin. Stool samples or rectal swabs were obtained for culture for enterococci within 24 h of transplantation and weekly while hospitalized.
Results:
Enterococci were isolated on stool culture from 38 (34%) of 102 patients at the time of transplantation; 4 (11%) of the isolates were VRE. The percentage of patients who subsequently acquired VRE was low (1-7% per wk) but remained constant during hospitalization. There was no association between new VRE detection and vancomycin use for either prophylactic or therapeutic purposes. Forty-four patients (39%) had a post-operative infection with 46% of these infections due to gram-positive organisms; rates were unaffected by prophylactic vancomycin use. Pancreas transplant patients who did not receive vancomycin prophylaxis had a significantly longer initial hospitalization (p = 0.03); however, differences were not statistically significant when total length of stay (LOS) within the first 90 d of transplantation was compared.
Conclusions:
Vancomycin surgical prophylaxis does not appear to have an effect on VRE colonization or infection, or on rates of infection with gram-positive bacteria. Elimination of vancomycin prophylaxis in renal transplant patients may be a reasonable part of an overall program to limit vancomycin usage, although as a single measure, its impact may be minimal. Vancomycin surgical prophylaxis may be of greater importance in pancreas transplants.
Insights
Vancomycin prophylaxis did not impact vancomycin-resistant enterococci (VRE) or gram-positive infections in organ transplant patients. Eliminating vancomycin may be considered for renal transplants, but it may be important for pancreas transplants.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Pharmacology
Background:
- Gram-positive organisms, including vancomycin-resistant enterococci (VRE), are significant pathogens in organ transplant recipients.
- The study investigated the hypothesis that vancomycin prophylaxis increases VRE risk versus the concern of increased morbidity from gram-positive infections without it.
Purpose of the Study:
- To evaluate the impact of vancomycin surgical prophylaxis on VRE colonization and infection rates in renal and pancreas transplant patients.
- To assess the effect of vancomycin prophylaxis on post-operative infections caused by gram-positive organisms.
Main Methods:
- Randomized controlled trial involving 88 renal and 24 pancreas transplant recipients.
- Patients received either vancomycin-based or cefazolin-based prophylactic regimens.
- Enterococcal stool cultures were performed pre-transplant and weekly during hospitalization.
Main Results:
- VRE was present in 11% of initial isolates; subsequent acquisition rates were low (1-7% weekly) and not associated with vancomycin use.
- Post-operative gram-positive infections occurred in 39% of patients, unaffected by prophylactic vancomycin.
- Pancreas transplant patients without vancomycin prophylaxis had longer initial hospitalizations, but overall 90-day length of stay was not significantly different.
Conclusions:
- Vancomycin surgical prophylaxis does not significantly affect VRE or gram-positive infection rates in this transplant population.
- Eliminating vancomycin prophylaxis in renal transplant patients could be part of a strategy to reduce vancomycin use.
- Vancomycin prophylaxis may retain importance for pancreas transplant recipients.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:16Treating Helicobacter pylori in Peptic Ulcers: Antimicrobial Therapy
01:26Kidney Transplant II: Surgical Procedure
01:28Antimicrobial Effectiveness