VRE in cirrhotic patients

Abstract

Background Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [ 1 ] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [ 2 ] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. Methods Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE ( n = 65) were separately compared to patients infected with gram-negative organisms ( n = 80) and uninfected patients ( n = 306). Results In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. Conclusions It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.

Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

“…In contrast, higher rates of VRE was observed in our study than reports from Singapore (9.3%) [55], Germany (9.8%) [49], Iran (9.4%) [56] and United Kingdom (9.2%) [57]. Different factors were identified as risk factors for acquiring VRE infections including previous hospitalization, patient transfer, urinary catheters, critical illnesses, underlying diseases, contact with VRE patients and inappropriate use of antibiotics [54,55,58,59]; all of which could contribute for the high prevalence of VRE in Ethiopia. Generally, infections and colonization with VRE were reported to be associated with health care contacts [18].…”

Fecal Microbiota Transplant in Cirrhosis Reduces Gut Microbial Antibiotic Resistance Genes: Analysis of Two Trials

“…Because vancomycin-resistant Enterococci are associated with poor outcomes in patients with and without cirrhosis, this potential reduction is encouraging. (22,23) These were accompanied by relatively low-level nonspecific ARGs for mupirocin, which is rarely used. It is also interesting that resistance to rifamycin antibiotics, such as rifaximin, which all patients were on, also decreased post-FMT compared to placebo.…”

Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

“…Our estimate was probably higher because our studies included animal and environmental sources in addition to clinical settings unlike all the studies listed above where they largely centred on clinical settings. This high prevalence could be as a result of various risk factors such as contact with VRE patients, infected animals, surfaces and objects, underlying conditions, serious illness, prior hospitalization, use of catheters, and improper antibiotic usage [ 45 ]. Camins et al [ 46 ] stated that health care contacts were the likely source of VRE colonization and infection, and this is plausible in situations where infection control knowledge, attitudes, and practices among healthcare workers, farmworkers, and the general population are poor in third-world countries [ 47 , 48 , 49 , 50 ] and Nigeria [ 26 ].…”