J Korean Soc Transplant.  2006 Dec;20(2):241-247.

Clinical Significance of Vancomycin Resistant Enterococcus in Liver Transplantation

• Choe EK
• Suh KS
• Cho JY
• Lee HW
• Cho EH
• Yi NJ
• Lee KU

Abstract

Purpose: Recently the incidence of vancomycin resistant enterococcus (VRE) infection and colonization has increased in the hospitalized patients. The purpose of present study is to examine the clinical significance of VRE infection and colonization in liver transplantation (LT) patients and to investigate the outcome.
Methods
Among 194 patients who underwent LT from January 2001 to July 2004, 15 patients had at least one report of culture positive of VRE (VRE(+)). We compared the clinical outcome of 15 VRE(+) patients with those of VRE(-) patients.
Results
One year mortality was higher in VRE(+) patients than VRE(-) patients (27% vs 4%; P=0.0001). Causes of death were primary graft non-function, infective endocarditis, MRSA sepsis and CMV pneumonitis. Mean duration of hospital stay was 102+/-63 days in VRE(+) patients, which shows significant difference with 51+/-30 days in VRE(-) patients (P=0.008). Cases who underwent gastroscopy (1.00+/-1.51 vs. 0.12+/-0.47; P=0.04) and percutaneous catheter drainage (1.33+/-1.49 vs. 0.40+/-1.05; P=0.03) were significantly more frequent in VRE(+) patients. The findings of gastroscopy were upper gastrointestinal bleeding (n=4), and bile duct obstruction (n=1). The contents of percutaneous catheter drainage were hematoma (n=3), bile juice (n=3) and ascites (n=1).
Conclusion
VRE infected patients experienced more frequently gastrointestinal tract complications including bleeding or biliary complication and they showed higher 1-year mortality rate, although these patients died of causes other than VRE infection.

Keyword

Liver transplantation; Vancomycin; Vancomycin resistant enterococcus; Infection; Colonization

MeSH Terms

Ascites
Bile
Catheters
Cause of Death
Cholestasis
Colon
Drainage
Endocarditis
Enterococcus*
Gastrointestinal Tract
Gastroscopy
Hematoma
Hemorrhage
Humans
Incidence
Length of Stay
Liver Transplantation*
Liver*
Methicillin-Resistant Staphylococcus aureus
Mortality
Pneumonia
Sepsis
Transplants
Vancomycin*
Vancomycin