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Published on: May 7, 2015
Recovery of vancomycin-resistant gram-positive cocci from pediatric liver transplant recipients
M Green1, K Barbadora, M Michaels
1Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania 15213.
Insights
Vancomycin-resistant gram-positive cocci (VRGPC) commonly colonize the stools of pediatric liver transplant patients early after transplant. While infection is rare, persistent colonization is frequent, highlighting the need for monitoring these resistant organisms.
Area of Science:
- Infectious Diseases
- Transplant Medicine
- Microbiology
Background:
- Pediatric liver transplant recipients are susceptible to infections.
- Vancomycin-resistant gram-positive cocci (VRGPC) pose a significant clinical challenge.
- Understanding colonization patterns is crucial for infection prevention in immunocompromised hosts.
Purpose of the Study:
- To prospectively monitor stool colonization with VRGPC in pediatric liver transplant recipients.
- To determine the incidence and clinical significance of VRGPC infections post-transplant.
- To characterize the types of VRGPC and their antibiotic susceptibility profiles.
Main Methods:
- Prospective monitoring of 49 pediatric liver transplant recipients over 12 months.
- Weekly quantitative stool cultures for VRGPC using selective media.
- Clinical monitoring for infection and systematic review of antibiotic use.
Main Results:
- VRGPC colonization was detected in 36 of 49 patients, increasing steadily in the first month.
- Enterococci were the most common VRGPC, with limited clearance observed.
- Three patients developed VRGPC infections (UTI, peritonitis), primarily caused by Enterococcus faecium.
Conclusions:
- Early stool colonization with VRGPC is common in pediatric liver transplant recipients.
- Infection due to VRGPC appears to be infrequent despite high colonization rates.
- Further research into the clinical impact and management of VRGPC colonization is warranted.
Abstract:
Between November 1988 and October 1989, 49 first-time pediatric liver transplant recipients at the Children's Hospital of Pittsburgh were prospectively monitored for the presence of stool colonization and the development of disease caused by vancomycin-resistant gram-positive cocci (VRGPC). Quantitative stool culturing was done on a weekly basis, and cultures were planted onto a selective medium for VRGPC. Isolates for which the MIC was greater than or equal to 8 were considered resistant to vancomycin. Patients were monitored clinically for the development of infection, and their charts were systematically reviewed for the use of antibiotics. Eighty-six isolates were recovered from 36 of the 49 patients. Enterococcal species were isolated from 31 patients and included Enterococcus gallinarum (n = 28), E. casseliflavus (n = 14), E. faecium (n = 9), E. faecalis (n = 2), E. mundtii (n = 2), and E. durans (n = 1). Stool colonization with vancomycin-resistant enterococci was noted to increase steadily during the first month after transplantation. Only 9 of 31 patients demonstrated clearance of these organisms in serial repeat cultures. Additional isolates of VRGPC included Lactobacillus confusus (n = 13), Lactobacillus spp. (n = 12), and Pediococcus pentosaceus (n = 4). Infection due to VRGPC developed in three patients: a urinary tract infection in two and peritonitis in one. E. faecium was the pathogen in each of these cases. The ranges of MICs of vancomycin were 8 to 32 micrograms/ml for all enterococcal isolates and greater than 128 micrograms/ml for Lactobacillus and Pediococcus isolates. All Lactobacillus and Pediococcus isolates were resistant to teicoplanin, although they were susceptible to daptomycin. All other isolates were susceptible to both teicoplanin and daptomycin. This study demonstrates that stool colonization with VRGPC may be a common and early finding among pediatric liver transplant recipients. However, infection appears to be uncommon.
