Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After...

Area of Science:

• Infectious Diseases
• Transplantation Medicine
• Antimicrobial Resistance

Background:

• Liver transplant recipients face risks for Enterococcus infections, including vancomycin-resistant Enterococcus (VRE).
• Data on daptomycin-resistant Enterococcus (DRE) impact in liver transplant (LT) patients are limited, with only one prior single-center study.
• Risk factors for VRE acquisition, such as immunosuppression and indwelling catheters, are common in LT recipients.

Purpose of the Study:

• To compare the outcomes of liver transplant recipients with daptomycin-resistant Enterococcus (DRE) bacteremia versus vancomycin-resistant Enterococcus (VRE) bacteremia.
• To identify risk factors and predictors associated with DRE bacteremia in liver transplant recipients.
• To assess the impact of DRE bacteremia on 1-year mortality following liver transplantation.

Main Methods:

• A retrospective, multicenter cohort study was conducted.
• Liver transplant recipients with either VRE or DRE bacteremia were compared.
• Multivariable logistic regression was used to analyze outcomes, adjusting for relevant covariates.

Main Results:

• Of 139 Enterococcus bacteremia cases post-LT, 78% were VRE and 22% were DRE.
• DRE bacteremia was associated with a 2.65-fold increased likelihood of 1-year mortality (aOR, 2.648; P = .044) after adjustment.
• Prior daptomycin exposure was an independent predictor of DRE bacteremia (aOR, 30.62; P < .001).

Conclusions:

• Daptomycin-resistant Enterococcus (DRE) bacteremia in liver transplant recipients is associated with significantly higher 1-year mortality compared to vancomycin-resistant Enterococcus (VRE).
• Findings support enhanced infection prevention and antimicrobial stewardship programs for transplant patients.
• Further research is warranted for novel antibiotics against DRE and practical strategies for preventing colonization and infection in high-risk LT recipients.