Comparison of risk factors and outcomes of daptomycin‐susceptible and ‐nonsusceptible vancomycin‐resistant Enterococcus faecium infections in liver transplant recipients

• Published in: Transplant infectious disease 2018-06, Vol.20 (3), p.e12856-n/a
• Main Authors: Lewis, J.D., Barros, A.J., Sifri, C.D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bleeding; Colonization; Complications; Daptomycin; Daptomycin - pharmacology; Daptomycin - therapeutic use; daptomycin‐nonsusceptibility; Demographics; Demography; Enterococcus; Enterococcus faecium; Enterococcus faecium - drug effects; Female; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - etiology; Humans; Infections; Kidney transplantation; Liver; Liver - drug effects; Liver diseases; liver transplant; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Male; Middle Aged; Mortality; Patients; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Transplantation; Transplants & implants; Vancomycin; Vancomycin - pharmacology; Vancomycin - therapeutic use; vancomycin resistance; Vancomycin-Resistant Enterococci - drug effects; Vancomycin-Resistant Enterococci - isolation & purification; Vancomycin-Resistant Enterococci - physiology
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12856

Background Vancomycin‐resistant Enterococcus faecium (VRE) infections are common in liver transplant recipients (LTRs). Daptomycin (DAP) is an important treatment for such infections; however, DAP‐nonsusceptible VRE (DNS‐VRE) are increasingly frequent. The purpose of this study was to compare clinical characteristics and outcomes of LTRs with infections due to DNS‐VRE and DAP‐susceptible VRE (DS‐VRE). Methods A single center, retrospective review of patients who underwent liver transplantation between January 1, 2010 and December 31, 2015 and developed infections due to DS‐VRE or DNS‐VRE post transplant was performed. Patients with DNS‐VRE and DS‐VRE infections were compared using univariate and logistic regression analysis. Results Fourteen LTRs developed DNS‐VRE and 20 LTRs developed DS‐VRE infection post‐transplantation. No significant differences were observed in demographics, model for end‐stage liver disease (MELD) scores, causes of end‐stage liver disease, or rate of pre‐transplant perirectal VRE colonization between groups. Bleeding complications and renal replacement therapy were more common in the DNS‐VRE group than in the DS‐VRE group. The duration of transplant hospitalization and post‐transplant intensive care unit (ICU) admission was longer in the DNS‐VRE group than in the DS‐VRE group. The 30‐day and 6‐month mortality rate associated with DNS‐VRE infection was similar to that associated with DS‐VRE infection. Conclusions Liver transplant recipients who develop DNS‐VRE infection have higher bleeding complications and longer, more complex hospitalizations compared to those who develop DS‐VRE infection post transplantation; however, mortality at 30 days and 6 months is not significantly worse. Further study is needed to determine optimal strategies for the prevention and treatment of DNS‐VRE infections in LTRs.