Impact of Enterococcal Bacteremia in Liver Transplant Recipients

Kim, Youn Jeong; Jun, Yoon Hee; Choi, Ho Joong; You, Young-Kyoung; Kim, Dong Goo; Choi, Jong Young; Yoon, Seung Kew; Kim, Sang Il

doi:10.1016/j.transproceed.2019.02.064

Cited by 17 publications

(21 citation statements)

References 15 publications

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“…Association of an inadequate dose of daptomycin with death was a key nding from the study. Our ndings are consistent with those reported in previous series [9][10][11][12]. These ndings may help solidify our understanding of the clinical features of VRE infection among liver transplant recipients.…”

Section: Discussionsupporting

confidence: 92%

“…Multiple factors have been studied as risk factors for graft failure including optimum donor selection; vascular, biliary, and immunological complications; and bacterial infection [32,33]. We agree with the suggestions from other studies that VRE infection may have contributed to graft failure in liver transplant recipients [10][11][12]. On the other hand, the greater number of graft failure in non-surviving patients in this study can be partly explained by the poor general condition including relatively higher Model for End-stage Liver Disease scores at the time of transplantation compared to survivors, although this difference did not reach statistical signi cance ( Table 2).…”

Section: Discussionsupporting

confidence: 81%

“…Moreover, 15% of these patients died within 30 days after development of VRE infection. Previous studies have indicated that the crude mortality rate of VRE infection among liver transplant recipients ranged from 23% to 82% [9,10,12,[22][23][24]. Excluding the data from an era before the availability of effective antibiotic treatment for VRE infection, the observed mortality rates for VRE bacteremia are still unacceptably high in this patient population (33% to 56%) [10,25].…”

Section: Discussionmentioning

confidence: 91%

“…VRE infection/colonization has been linked to prolonged length of hospitalization, higher costs of hospitalization, and increased mortality in hospitalized patients [7,8]. Notably, poor outcomes have been reported among liver transplant recipients with VRE infection [9][10][11][12]. McNeil et al revealed that the 90-day mortality was signi cantly higher among those who developed VRE infection after liver transplantation [9].…”

Section: Importance Of Daptomycin Dosage On the Clinical Outcomes In mentioning

confidence: 99%

“…McNeil et al revealed that the 90-day mortality was signi cantly higher among those who developed VRE infection after liver transplantation [9]. In addition, patients with VRE infection had worse graft survival than those without VRE infection [10][11][12]. Treatment options for VRE are limited.…”

mentioning

confidence: 99%

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Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

Lee¹,

Sng²,

Li³

et al. 2021

Preprint

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Background: The prevalence of vancomycin-resistant enterococci (VRE) is increasing among liver transplant recipients. This study aimed to explore the clinical features of liver transplant recipients with VRE infection/colonization and to determine the impact of daptomycin dosage on the outcomes. Methods: We retrospectively enrolled pre-transplant and post-transplant patients with VRE colonization/infection from 2016 to 2019. Results: Altogether, 428 patients underwent liver transplantation. Among these, 22 (5.1%) patients developed VRE colonization/infection. All VRE isolates were Enterococcus faecium. Two (9%) patients acquired VRE in the pre-transplant period, 16 (3 colonizations and 13 infections) (72.7%) in the early post-liver transplant period (≤60-day after transplantation), and 4 (2 colonization and 2 infections) (18.1%) in the late post-liver transplant period (>6-month after transplantation). Among 13 patients with early post-liver transplant VRE infection, 12 (92.3%) underwent living-donor liver transplantation and 1 underwent deceased donor liver transplantation. Among these 13 patients, the median time from transplant to emergence of VRE infection was 12 days. The median interval from VRE infection to death was 27 days and the 30-day mortality was 67%. Of these 13 patients, eleven patients (8 survived; 3 died) received daptomycin therapy for VRE. Among them, 4 (36.3%) received daptomycin doses <8 mg/kg. Non-survivors (n=3) received significantly lower daptomycin dose than survivors (n=8) (P=0.040). Daptomycin doses <8mg/kg were more frequently associated with non-survivors (n=3) than with survivors (n=8) (P=0.024). Conclusions: In summary, the suboptimal dosage of daptomycin may have contributed to a higher rate of in-hospital mortality. Doses ≥8 mg/kg may be needed to adequately treat VRE infection in early post-liver transplant recipients.Level of evidence: Level III

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 91%

Section: Importance Of Daptomycin Dosage On the Clinical Outcomes In mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

Lee¹,

Sng²,

Li³

et al. 2021

Preprint

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Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

Walti

2022

Curr Infect Dis Rep

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Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae , are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.

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Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

Dumford

Skalweit

2020

Infectious Disease Clinics of North America

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Impact of Enterococcal Bacteremia in Liver Transplant Recipients

Cited by 17 publications

References 15 publications

Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

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