Korean J Crit Care Med.  2006 Dec;21(2):95-100.

Vancomycin-resistant Enterococcus and Methicillin-resistant Staphylococcus aureus Colonization in Liver Transplant Recipients : A Matched Control Study

• Jeong JY
• Kim S
• Bae SS
• Jung CW
• Lee KH

Abstract

BACKGROUND
Despite improvements in surgical technique and immunosuppression, infection following liver transplantation (LT) remains a significant problem. Vancomycin-resistant Enterococcuscus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have become important nosocomial pathogens. This study was undertaken in attempt to evaluate clinical impact of VRE and MRSA in LT recipients.
METHODS
LT recipients with VRE or MRSA colonization from 2001 to 2004 were identified and matched (age, gender, United Network for Organ Sharing status, liver disease, and transplant date) to control groups without MRSA or VRE colonization. Demographics, clinical factors, length of stay, duration of the use of the mechanical ventilator, complications and survival rates were compared with matched controls.
RESULTS
Eleven patients were colonized by VRE (4.7%) and thirty patients by MRSA (13%). The common sites of VRE culture included the tip of the urinary catheter and urine. The VRE colonized group experienced more biliary complications, relaparotomies, longer length of stay at ICU and ward, and longer use of the mechanical ventilator. One year survival rate was lower in the VRE group. MRSA was commonly cultured from sputum, tip of the central venous catheter or intraarterial catheter, and blood. The MRSA group experienced more relaparotomies, pneumonia, longer stay at ICU and ward, and longer use of mechanical ventilator compared to the control. One year survival rate was lower in the MRSA group. Rejection was not associated with VRE or MRSA infection.
CONCLUSIONS
VRE or MRSA colonization is associated with higher incidence of posttransplant complications and lower survival rate than LT recipients without VRE or MRSA colonization. The patients with VRE or MRSA colonization also utilized more hospital resources.

Keyword

Liver transplantation; Methicillin-resistant Staphylococcus aureus; Vancomycin-resistant Enterococcus

MeSH Terms

Catheters
Central Venous Catheters
Colon*
Demography
Enterococcus*
Humans
Immunosuppression
Incidence
Length of Stay
Liver Diseases
Liver Transplantation
Liver*
Methicillin Resistance*
Methicillin-Resistant Staphylococcus aureus*
Pneumonia
Sputum
Survival Rate
Transplantation*
Urinary Catheters
Ventilators, Mechanical