Impact of an Aggressive Infection Control Strategy on Endemic <i>Staphylococcus aureus</i> Infection in Liver Transplant Recipients

Singh, Nina; Squier, Cheryl; Wannstedt, Cheryl; Keyes, Lois; Wagener, Marilyn M.; Cacciarelli, Thomas V.

doi:10.1086/500651

Cited by 72 publications

(56 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17,18 Our most notable findings concerned the outcomes of these infections. Contrary to prior reports of high mortality rates among solid organ transplant recipients with staphylococcal infections, 15,19 we found that the 30-and 90-day mortality rates were only 7% and 12%, respectively. However, lung transplant recipients with early-onset S aureus infections were significantly more likely to die at 3 years and have ACR or chronic rejection than those without such infections.…”

Section: Discussioncontrasting

confidence: 99%

Staphylococcus aureus infections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

Shields

Clancy

Minces

et al. 2012

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

Section: Discussioncontrasting

confidence: 99%

Staphylococcus aureus infections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

Shields

Clancy

Minces

et al. 2012

The Journal of Heart and Lung Transplantation

View full text Add to dashboard Cite

“…The pooled effects and sensitivity analyses are displayed in Table 2. Before transplantation, the estimated MRSA colonization was 8.5% (95% CI 3.2-15.8; effect derived from nine studies (13)(14)(15)19,(21)(22)(23)29,33) in 2885 patients (t 2 ¼ 0.107) and VRE colonization was 11.9% (95% CI 6.8-18.2; effect derived from eight studies (14,17,18,20,24,25,35,36) that included 1381 patients (t 2 ¼ 0.060). Effects referred to liver patients exclusively for VRE, whereas for MRSA two out of nine eligible studies reported data on kidney and/or pancreas and lung patients (13,33).…”

Section: Resultsmentioning

confidence: 99%

“…In the postoperative screening, the estimated MRSA colonization was derived from six studies (12)(13)(14)(15)21,32) with 2342 patients (three on liver transplant recipients, one on lung recipients, one on kidney and one on kidney and/or pancreas) and it was 9.4% (95% CI 3.0-18.5; t 2 ¼ 0.096) and across eight VRE studies (14,(16)(17)(18)20,27,30,36) with 1369 patients (six on liver transplant recipients, one on kidney and one on kidney and/or pancreas), colonization was 16.2% (95% CI 10.7-22.6); t 2 ¼ 0.051. There was no evidence of publication bias for MRSA (Egger's bias ¼ 7.15, p ¼ 0.16), or VRE (Egger's bias ¼ 1.12, p ¼ 0.76).…”

Section: Resultsmentioning

confidence: 99%

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Ziakas

Pliakos

Zervou

et al. 2014

American Journal of Transplantation

103

View full text Add to dashboard Cite

The burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) colonization among the increasing number of solid organ transplant patients has not been systematically explored. We searched PubMed and EMBASE for pertinent articles, performed a metaanalysis of prevalence across eligible studies and estimated the risk of ensuing MRSA or VRE infections relative to colonization status. We stratified effects in the pretransplant and posttransplant period. Twentythree studies were considered eligible. Seventeen out of 23 (74%) referred to liver transplants. Before transplantation, the pooled prevalence estimate for MRSA and VRE was 8.5% (95% confidence interval [CI] 3.2-15.8) and 11.9% (95% CI 6.8-18.2), respectively. MRSA estimate was influenced by small studies and was lower (4.0%; 95% CI 0.4-10.2) across large studies (>200 patients). After transplantation, the prevalence estimates were 9.4% (95% CI 3.0-18.5) for MRSA and 16.2% (95% CI 10.7-22.6) for VRE. Pretransplant as well as posttransplant MRSA colonization significantly increased the risk for MRSA infections (pooled risk ratio [RR] 5.51; 95% CI 2. respectively). Pretransplant and posttransplant VRE colonization were also associated with significant risk of VRE infection (RR 6.65; respectively). Solid organ transplantation is a high-risk setting for MRSA and VRE colonization, and carrier state is associated with infection. Upgraded focus in prevention and eradication strategies is warranted.

show abstract

“…This can be due to many factors: (1) the lower incidence of polymicrobial infections in our study, considering that Wagener et al 31 reported polymicrobial infection was associated with increased mortality after solid organ transplantation; and (2) the lower incidence of invasive fungemia and pneumocystic diseases due to the use of prophylactic antifungal drugs and antibiotics, which proved to minimize the incidence of, and thus mortality from, infection. 30,32,33 For the duration of the study period, the number of deaths due to infection decreased in era 2 compared to era 1; moreover, the pattern of some infection changed between era 1 and era 2 with higher incidence of MRSA in the older era. This may be attributed to the consultation with infectious disease physicians in the treatment decisions that emphasize adequate treatment, which help to improve outcome of MRSA infection and decrease the incidence of deaths due to infection.…”

Section: Discussionmentioning

confidence: 99%

Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience

et al. 2011

View full text Add to dashboard Cite

Infection after pediatric living donor liver transplantation (LDLT) is a major cause of morbidity and mortality. Here, we sought to determine the incidence, timing, location, and risk factors for bacterial and fungal infections. We retrospectively investigated infection for 3 postoperative months in 345 consecutive pediatric patients (56.2% were females) who underwent primary LDLT at Kyoto University Hospital, Japan. A total of 179 patients (51.9%) developed at least 1 bacterial and/or fungal infection episode, with an infection rate of 2.5 per patient. The predominant infection site was the surgical site (52%). Most of the bacterial and fungal infection occurred within the first month. Enterococcus species followed by multidrug-resistant Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus were the predominant bacterial pathogens. All fungal isolates were Candida species. Prolonged preoperative hospital stay more than 7 days (P ¼ 0.025) and bile leak (P ¼ 0.047) were independent predictors of bacterial infection. Preoperative ascites (P ¼ 0.009) and prolonged insertion of intravascular catheters (P ¼ 0.001) independently predicted fungal infections. Bacterial and fungal infections were responsible for 42.9% of the causes of death in our study. To avoid bacterial and fungal infections after LDLT, broader-spectrum prophylaxis to cover the range of organisms seen in these infections should be considered as a more favorable treatment regimen to prevent prophylaxis failure, especially for patients with a preoperative hospital stay more than 7 days or operative complications in the form of a bile leak. Early drain removal and prophylactic antifungal drugs should be considered for patients with preoperative ascites. Cooperation between attending physicians and infectious disease physicians can improve the outcome of patients after LDLT. Liver Transpl 17:976-984, 2011. V C 2011 AASLD.Received September 28, 2010; accepted January 15, 2011.Liver transplantation (LT) is the treatment of choice for end-stage liver disease.1 Living donor liver transplantation (LDLT) is one way to perform LT and the most effective alternative for patients in areas where there is a shortage of available deceased donors for LT, e.g., Japan.2 Infection represents a major cause of

show abstract

Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients

Cited by 72 publications

References 19 publications

Staphylococcus aureus infections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

Staphylococcus aureus infections in the early period after lung transplantation: Epidemiology, risk factors, and outcomes

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11-year single-center experience

Contact Info

Product

Resources

About