Methicillin-Resistant Staphylococcus aureus: The Other Emerging Resistant Gram-Positive Coccus among Liver Transplant Recipients

• Published in: Clinical infectious diseases 2000-02, Vol.30 (2), p.322-327
• Main Authors: Singh, Nina, Paterson, David L., Chang, Feng Yee, Gayowski, Timothy, Squier, Cheryl, Wagener, Marilyn M., Marino, Ignazio R.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia; Bacterial pneumonia; Biological and medical sciences; Clinical Articles; Cross Infection - drug therapy; Cross Infection - epidemiology; Cross Infection - etiology; Cytomegalovirus; Female; Gram-Positive Bacterial Infections - drug therapy; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - mortality; Humans; Incidence; Infections; Intensive care units; Length of Stay; Liver; Liver transplantation; Liver Transplantation - adverse effects; Male; Medical sciences; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Mortality; Odds Ratio; Pennsylvania - epidemiology; Pharmacology. Drug treatments; Registries; Risk Factors; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcal Infections - etiology; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Statistics, Nonparametric; Survival Rate; Transplantation
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/313658

We undertook a study of the characteristics and clinical impact of infections due to methicillin-resistant Staphylococcus aureus (MRSA) after liver transplantation. Of 165 patients who received liver transplants at our institution from 1990 through 1998, 38 (23%) developed MRSA infections. The predominant sources of infection were vascular catheters (39%; n = 15), wound (18%; n = 7), abdomen (18%; n = 7), and lung (13%; n = 5). A significant increase in MRSA infections (as a percentage of transplant patients infected per year) occurred over time (P =.0001). This increase was greater among intensive care unit patients (P =.001) than among nonintensive care unit hospital patients (P=.17). Cytomegalovirus seronegativity (P =.01) and primary cytomegalovirus infection were significantly associated with MRSA infections (P =.005). Thirty-day mortality among patients with MRSA infections was 21% (8/38). Mortality was 86% in patients with bacteremic MRSA pneumonia or abdominal infection and 6% in those with catheter-related bacteremia (P =.004). Thus the incidence of MRSA infection has increased exponentially among our liver transplant recipients since 1990. These infections have unique risk factors, time of onset, and a significant difference in site-specific mortality; deep-seated bacteremic infections, in particular, portend a grave outcome.