A single‐center experience with infections due to daptomycin‐nonsusceptible Enterococcus faecium in liver transplant recipients

Abstract

This study, the largest published series to our knowledge of DNSE infections in LTRs, demonstrates that these infections occur in patients with serious surgical complications and are associated with high morbidity and mortality. Established risk factors for VRE infection were common, as was DAP exposure. Although many risk factors for DNSE infection cannot be changed, this case series identifies several potentially modifiable variables. Further work is needed to identify interventions to decrease the risk of developing DNSE infections in this complex patient population.

Epidemiology, risk factors, and outcomes of infections in patients undergoing liver transplantation for hilar cholangiocarcinoma

“…In recent years, there has been a significant increase in multidrug resistant bacterial infections in solid organ transplant (SOT) recipients. [15][16][17] In contrast to older studies in which gram-negative bacterial infections caused most infections in LT recipients, gram-positive cocci were the predominant pathogens causing BSI and abdominal infections in our study. 18 Abdominal infections were significantly associated with increased patient mortality in our study.…”

“…Recipient VRE colonization was a significant risk factor for time to first post‐transplant infection and also specifically for BSI. In recent years, there has been a significant increase in multidrug resistant bacterial infections in solid organ transplant (SOT) recipients . In contrast to older studies in which gram‐negative bacterial infections caused most infections in LT recipients, gram‐positive cocci were the predominant pathogens causing BSI and abdominal infections in our study .…”

Daptomycin non-susceptible Enterococcus faecium in leukemia patients: Role of prior daptomycin exposure

“…The daptomycin minimum inhibitory concentration (MIC) was determined via Etest (bioMérieux) with daptomycin non-susceptibility defined as an MIC of >4 mg/L, in accordance with current Clinical Laboratory and Standards Institute (CLSI) definitions (http://clsi.org/m100/). We chose Etest since compelling evidence suggests that Etest more accurately identifies DNSE compared to broth microdilution (4, 8). The linezolid MIC was determined via Etest, while ampicillin and vancomycin MICs were determined via automated broth microdilution (Vitek 2).…”

Comparison of risk factors and outcomes of daptomycin‐susceptible and ‐nonsusceptible vancomycin‐resistant enterococcus faecium infections in liver transplant recipients; A reply to Lewis et al

“…To the Editor, Daptomycin resistance is emerging and is associated with liver transplantation (LTX). 1,2 The outcomes of patients infected with daptomycin-nonsusceptible-enterococci (DNSE) with minimum inhibitory-concentrations (MIC) > 4 mg/L are unfavorable. As a result, some have recommended reducing the breakpoint for DAP susceptibility in enterococci to ≤2 mg/L.…”