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Nosocomial infections with vancomycin-resistant Enterococcus faecium in liver transplant recipients: risk factors for
G A Papanicolaou1, B R Meyers, J Meyers
1Division of Infectious Diseases, Mount Sinai Medical Center, New York, New York, USA.
Abstract:
The risk factors for acquisition of and mortality due to nosocomial infection with vancomycin-resistant Enterococcus faecium (VREF) in orthotopic liver transplant (OLT) recipients were studied at a tertiary care hospital; 32 VREF-infected OLT patients (cases) were compared with 33 randomly selected OLT recipients (controls). More antibiotics were administered preoperatively to cases (mean, 4 antibiotics per patient for 474 antibiotic-days) than to controls (mean, 1.8 antibiotics per patient for 131 antibiotic-days). Cases were more likely than controls to have received vancomycin therapy preoperatively and to have been hospitalized in the intensive care unit (ICU) preoperatively. Logistic regression revealed that the risk factors for acquisition of VREF infection were surgical reexploration and a prolonged stay in the surgical ICU postoperatively. In the cases, the risk factors for mortality were admission to the ICU preoperatively and hemodialysis. The mortality rate associated with polymicrobial bloodstream infections was 100% despite appropriate therapy. Sixteen and 18 cases received parenteral chloramphenicol and doxycycline, respectively, for treatment of VREF infection. There were no hematologic adverse effects attributed to chloramphenicol treatment. DNA analysis of selected E. faecium isolates suggested that infections were due to multiple clones. In summary, the source of VREF infection in OLT patients is the gastrointestinal tract. Antibiotic selective pressure may contribute to colonization. Infection with VREF is a predictor of morbidity and mortality in OLT patients.
Insights
Vancomycin-resistant Enterococcus faecium (VREF) infections pose significant risks for orthotopic liver transplant (OLT) recipients. Key risk factors include prior antibiotic use, ICU stays, and surgical reexploration, leading to increased morbidity and mortality.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Critical Care Medicine
Background:
- Nosocomial infections, particularly those caused by vancomycin-resistant Enterococcus faecium (VREF), are a serious concern in immunocompromised patient populations.
- Orthotopic liver transplant (OLT) recipients represent a vulnerable group susceptible to healthcare-associated infections due to their complex medical status and immunosuppression.
Purpose of the Study:
- To identify and analyze the risk factors associated with the acquisition of and mortality due to VREF infections in OLT recipients.
- To compare VREF-infected OLT patients with a control group to elucidate specific predisposing and contributing factors.
Main Methods:
- A case-control study was conducted comparing 32 VREF-infected OLT patients with 33 randomly selected OLT recipients.
- Data collected included preoperative and postoperative factors, antibiotic exposure, and intensive care unit (ICU) utilization.
- Logistic regression analysis was employed to determine significant risk factors for VREF acquisition and mortality.
Main Results:
- Preoperative administration of multiple antibiotics and vancomycin therapy were more common in VREF-infected cases.
- Surgical reexploration and prolonged postoperative ICU stay were identified as risk factors for VREF acquisition.
- Preoperative ICU admission and hemodialysis were significant risk factors for mortality in VREF-infected OLT patients.
Conclusions:
- The gastrointestinal tract is a likely source of VREF in OLT patients, with antibiotic selective pressure potentially driving colonization.
- VREF infection is a significant predictor of increased morbidity and mortality in OLT recipients.
- Targeted interventions focusing on antibiotic stewardship and infection control in ICUs are crucial for mitigating VREF risks in OLT patients.
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