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A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures
Published on: February 10, 2011
Effect of Intraoperative Single-Shot Application of Vancomycin in Liver Transplant Recipients on Postoperative
Christian Siebers1, Johannes Kinzinger, Ludwig C Hinske
1From the Department of Anaesthesiology, Ludwig-Maximilians University, Ludwig-Maximilians University, Munich, Germany.
Objectives:
Infections are major causes of morbidity and mortality in the early postoperative period after liver transplant. We observed a high rate of enterococcal infections at our center. Therefore, we added an intraoperative single shot of vancomycin to the standard regimen of meropenem given over 5 days. The aim of this study was to determine the prevalence of both Enterococcus faecium and Enterococcus faecalis infections during the first 28 days after surgery depending on the type of antibiotic prophylaxis and their implications on mortality and morbidity.
Materials And Methods:
Our retrospective cohort analysis included 179 patients: 93 patients received meropenem only and 86 patients were treated with meropenem plus vancomycin.
Results:
During the first 28 days after transplant, microbiological tests showed that 51 patients (28.5%) were positive for Enterococcus faecium and 25 patients (14.0%) were positive for Enterococcus faecalis. Enterococcus faecium infections appeared significantly more often in patients without vancomycin (P = .013). In the second week after transplant, there was a significant reduction in Enterococcus faecium infections in the meropenem plus vancomycin group (P = .015). Enterococcus faecalis infections occurred more often in the patients receiving meropenem alone, but results were not statistically significant (P = .194). There was a trend toward more frequent renal replacement therapy in the meropenem plus vancomycin group. We found no differences between the groups regarding survival after 1 and 2 years, length of hospital stay, or duration in the intensive care unit. Overall 1-year survival was 78.8% (141/179 patients).
Conclusions:
Although postoperative Enterococcus species infections can be reduced after liver transplant by adding vancomycin to the intraoperative antibiotic regimen, it does not improve the long-term outcomes.
Insights
Adding vancomycin to meropenem reduced enterococcal infections after liver transplant, particularly Enterococcus faecium. However, this antibiotic prophylaxis did not improve long-term patient survival or other outcomes.
Area of Science:
- Transplant Surgery
- Infectious Diseases
- Pharmacology
Background:
- Postoperative infections are a significant cause of morbidity and mortality in liver transplant recipients.
- Enterococcal infections are prevalent in the early postoperative period following liver transplantation.
Purpose of the Study:
- To evaluate the impact of adding vancomycin to meropenem on the incidence of Enterococcus faecium and Enterococcus faecalis infections within 28 days post-liver transplant.
- To assess the implications of different antibiotic prophylaxis regimens on mortality and morbidity in liver transplant patients.
Main Methods:
- Retrospective cohort analysis of 179 liver transplant patients.
- Comparison of outcomes between patients receiving meropenem alone (n=93) and meropenem plus vancomycin (n=86).
Main Results:
- Enterococcus faecium infections were significantly more frequent in patients without vancomycin (P = .013).
- A significant reduction in Enterococcus faecium infections was observed in the second week post-transplant for the vancomycin group (P = .015).
- No statistically significant differences were found for Enterococcus faecalis infections, overall survival, hospital stay, or ICU duration.
Conclusions:
- Intraoperative vancomycin prophylaxis can decrease postoperative Enterococcus species infections after liver transplant.
- Adding vancomycin to the standard antibiotic regimen does not enhance long-term outcomes such as survival or hospital length of stay.
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