Vancomycin-resistant Enterococcus in liver transplant patients

Orloff, Susan L.; Busch, Ann M. Herbage; Olyaei, Ali J.; Corless, Christopher L.; Benner, Kent G.; Flora, Ken; Rosen, Hugo R.; Rabkin, John M.

doi:10.1016/s0002-9610(99)00083-5

Cited by 65 publications

(60 citation statements)

References 23 publications

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“…Thus, for at least two thirds of the VRE-colonized transplant candidates, precluding liver transplantation on the basis of VRE colonization ''until the colonization has been definitively eradicated'' may mean precluding liver transplantation altogether. In addition, in the study by Orloff et al, 2 the mortality rate in patients colonized with VRE was only 7%, which is less than the 14% mortality rate at 1 year for non-VRE transplant patients. Conversely, the mortality rate for VRE-colonized patients who did not proceed to transplantation was 100%.…”

Section: Commentsmentioning

confidence: 85%

“…7 It is difficult to define the mortality directly attributable to VRE infection. In the study by Orloff et al, 2 VRE infection was believed to contribute to death in 8 patients who had persistent VRE bacteremia and/or peritonitis. Although VRE seem to more often cause life-threatening diseases than their vancomycinsusceptible counterparts, it is not clear whether it is the VRE themselves that are independently associated with increased mortality rates.…”

Section: Commentsmentioning

confidence: 98%

“…The article by Orloff et al is a retrospective review of VRE colonization and infection in liver transplant recipients at Oregon Health Sciences University and Portland Veterans Affairs Medical Center. 2 From October 1994 through September 1998, 126 isolates of VRE were identified in 42 of 234 liver transplant recipients and 5 liver transplant candidates who did not proceed to transplantation. The 1-year mortality rate for patients with VRE infection was 82%, whereas for those with VRE colonization, it was 7%.…”

Section: Commentsmentioning

confidence: 99%

“…Because routine VRE screening of liver transplant recipients was not performed, I suspect there were likely several VRE-colonized patients who were not identified. 2 For example, we have studied the natural history of VRE colonization and infection in our liver transplant population (R. Patel, unpublished data). At the Mayo Clinic, routine aerobic bacterial throat, rectal, wound, biliary, and urinary cultures have been collected from liver transplant recipients as a part of a selective bowel decontamination program since 1985.…”

Section: Commentsmentioning

confidence: 99%

“…Fortunately, quinupristin/dalfopristin was recently approved (after the publication of the article by Orloff et al 2 ) for the treatment of patients with serious or life-threatening infections associated with vancomycin-resistant E faecium, and several new agents for the treatment of VRE are being developed, including linezolid, ziracin, daptomycin, LY333328, GAR-936, and others. 2 These agents should improve the outcomes of VRE-infected liver transplant recipients.…”

Section: Commentsmentioning

confidence: 99%

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Vancomycin-resistant enterococci in liver transplant recipients

Patel

2000

Liver Transpl

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Section: Commentsmentioning

confidence: 85%

Section: Commentsmentioning

confidence: 98%

Section: Commentsmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

Section: Commentsmentioning

confidence: 99%

See 3 more Smart Citations

Vancomycin-resistant enterococci in liver transplant recipients

Patel

2000

Liver Transpl

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The role of selective digestive decontamination for reducing infection in patients undergoing liver transplantation: A systematic review and meta-analysis

2004

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Selective digestive decontamination (SDD) refers to the use of antimicrobials to reduce the burden of aerobic gram-negative bacteria and/or yeast in the intestinal tract to prevent infections caused by these organisms. Liver transplant patients are highly vulnerable to bacterial infection particularly with gram-negative organisms within the first month after transplantation, and SDD has been proposed as a potential measure to prevent these infections. However, the benefit of this procedure remains controversial. We undertook a systematic review and meta-analysis to determine whether SDD is beneficial in reducing infections overall and those caused by gramnegative bacteria in patients following liver transplantation. All studies that evaluated the efficacy of SDD in liver transplant patients were included. Randomized trials that included liver transplant patients given SDD versus either placebo or no treatment or minimal treatment (e.g., oral nystatin alone), and that provided adequate data to calculate a relative risk ratio, were included in the meta-analysis. Our review shows that most studies found SDD to be effective in reducing gram-negative infection. The nonrandomized and uncontrolled trials also showed benefit with SDD in reducing overall infection; however, the effect on overall infection was limited in the 4 randomized trials, in which the pooled relative risk was 0.88 (95% CI, 0.7-1.1), indicating no statistically significant reduction in infection with the use of SDD. The summary risk ratio for the association between SDD and gram-negative infection was 0.16 (95% CI, 0.07-0.37), indicating an 84% relative risk reduction in the incidence of infection caused by gram-negative bacteria in patients receiving SDD in randomized trials. In conclusion, the available literature supports a beneficial effect of SDD on gram-negative infection following liver transplantation; however, the risk of antimicrobial resistance must be considered. Larger multicenter randomized trials in this patient population to assess the effect of SDD in reducing infection and mortality, while assessing the risk of antimicrobial resistance, are needed. (Liver Transpl 2004;10:817-827.)

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