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Methicillin-resistant Staphylococcus aureus: the other emerging resistant gram-positive coccus among liver transplant
N Singh1, D L Paterson, F Y Chang
1Veterans Affairs Medical Center and University of Pittsburgh, Thomas E. Starzl Transplantation Institute, PA 15240, USA. nis5+@pitt.edu
Abstract:
We undertook a study of the characteristics and clinical impact of infections due to methicillin-resistant Staphylococcus aureus (MRSA) after liver transplantation. Of 165 patients who received liver transplants at our institution from 1990 through 1998, 38 (23%) developed MRSA infections. The predominant sources of infection were vascular catheters (39%; n=15), wound (18%; n=7), abdomen (18%; n=7), and lung (13%; n=5). A significant increase in MRSA infections (as a percentage of transplant patients infected per year) occurred over time (P=.0001). This increase was greater among intensive care unit patients (P=.001) than among nonintensive care unit hospital patients (P=.17). Cytomegalovirus seronegativity (P=.01) and primary cytomegalovirus infection were significantly associated with MRSA infections (P=.005). Thirty-day mortality among patients with MRSA infections was 21% (8/38). Mortality was 86% in patients with bacteremic MRSA pneumonia 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 unique risk factors, time of onset, and a significant difference in site-specific mortality; deep-seated bacteremic infections, in particular, portend a grave outcome.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in liver transplant recipients. These infections present unique risks and varying mortality rates depending on the infection site.
Area of Science:
- Infectious Diseases
- Transplantation Medicine
- Clinical Microbiology
Background:
- Liver transplantation is a complex procedure with potential complications.
- Post-transplant infections pose a significant threat to patient outcomes.
- Methicillin-resistant Staphylococcus aureus (MRSA) is a notable pathogen in healthcare settings.
Purpose of the Study:
- To investigate the characteristics of MRSA infections following liver transplantation.
- To determine the clinical impact and outcomes of MRSA infections in this patient population.
- To identify risk factors and trends associated with MRSA infections post-liver transplant.
Main Methods:
- Retrospective study of 165 liver transplant recipients from 1990-1998.
- Analysis of MRSA infection incidence, sources, and associated factors.
- Evaluation of 30-day mortality rates based on infection type and site.
Main Results:
- 23% of liver transplant patients developed MRSA infections.
- Infections predominantly originated from vascular catheters, wounds, abdomen, and lungs.
- A significant increase in MRSA infections over time was observed, particularly in ICU patients.
- Cytomegalovirus seronegativity and primary CMV infection were associated risk factors.
- 30-day mortality was 21%, with higher rates for bacteremic pneumonia/abdominal infections (86%) compared to catheter-related bacteremia (6%).
Conclusions:
- MRSA infections have increased exponentially in liver transplant recipients since 1990.
- These infections exhibit distinct risk factors, onset patterns, and site-specific mortality.
- Deep-seated bacteremic MRSA infections carry a grave prognosis in liver transplant patients.