High Mortality Related with Staphylococcus aureus Bacteremia After Liver Transplantation

Abstract

The aim of the present study was to analyze the characteristics of bacteremia occurring in liver-transplant patients in Andalusia, Spain, during the 1990s. At the three participating hospitals, 405 liver transplantations were performed during the study period, and 119 bacteremic episodes were observed following 91 of them (22.4%, 29.4 episodes/100 liver transplants). Gram-positive organisms were the predominant bacteria isolated in cases of early-onset bacteremia (70.7%, P=0.04). The most common sources of bacteremia were the abdomen (33.6%) and intravascular catheters (22.7%), but frequently the source of bacteremia was unknown (31.9%). Mortality at 30 days was 21%. Isolation of Staphylococcus aureus was the only independent risk factor for mortality (relative risk, 3.13; 95% confidence interval, 1.3-7.5; P=0.01). These results indicate that control measures are required in order to reduce the incidence of gram-positive bacteremia and catheter-related infection in this patient population. The observed etiology must be considered when empirical antimicrobial therapy is indicated while awaiting blood-culture results.

<div>Methicillin-resistant <em>Staphylococcus aureus</em> bacteremia among liver transplant recipients: epidemiology and associated risk factors for morbidity and mortality</div>

“…Previous studies revealed that S. aureus was responsible for 2.3%–46.3% 5 , 9 , 14 , 15 , 18 – 20 , 27 – 32 , 35 – 37 , 42 – 49 of all pathogens causing bacteremia among liver recipients and MRSA was 1.6%–41.4%. 5 , 9 , 14 , 15 , 18 , 19 , 27 , 35 , 36 , 44 , 45 , 49 , 50 In a case report, Doucette et al 51 claimed that S. aureus accounted for half of four cases wherein donor-derived bacteremias were transmitted to liver recipients, despite appropriate antibiotic prophylaxis. The incidence rates of S. aureus /MRSA in all pathogens causing bacteremia among liver recipients are shown in Table 2 .…”

“…The morbidity of S. aureus bacteremia varied from 0.6% to 29% among liver recipients, 5 , 9 , 14 – 36 and for MRSA bacteremia, it was 0.4%–27.4%. 5 , 6 , 9 , 14 , 15 , 17 , 19 , 22 , 23 , 26 , 35 , 37 – 40 According to a study conducted at the Pittsburgh VA Medical Center, of 233 consecutive liver recipients, 3.8% underwent MRSA bacteremia during 1989–1993, 24.5% during 1993–1995, 30% during 1996–1998 and 11.3% during 1998–2003. 37 …”

“… 17 , 20 , 52 , 53 A patient’s colonized skin is also a usual source of S. aureus bacteremia after LT. 54 Other studies reported that the principle sources of S. aureus bacteremia in liver recipients included primary infection (including either intravascular catheters or unknown source) (21.4%–57.7%), abdominal or biliary tract (7%–33.6%), lung (6%–55%), urogenital tract (1.3%–17%), gastrointestinal tract (52.8%), endocarditis (3.8%), surgical wounds (1.3%–33%) and donor transmission (1.2%). 4 , 14 , 15 , 21 , 25 , 34 , 35 , 41 , 45 , 46 , 51 , 55 – 57 …”

Staphylococcus aureus bacteremias following liver transplantation: a clinical analysis of 20 cases

“…Staphylococcus aureus bacteremia is an important issue complicating the clinical course of liver recipients and has been associated with significant morbidity and mortality, as shown in previous studies with a reported incidence rate of 15%–66% and a mortality rate of 21% 1–3. Our previous study revealed that S. aureus was responsible for 26% of all pathogens causing bacteremias among liver transplant recipients 4…”

“…Some researchers have reported a high incidence of methicillin-resistant S. aureus (MRSA) in liver transplant recipients 3,5,6. The increasing antibiotic-resistant S. aureus has emerged as a pivotal factor that influences the prognosis and survival of liver transplant recipients.…”