Management of vancomycin-resistant Enterococci and daptomycin-resistant Enterococci infections in liver transplant recipients in a single academic center.

Autor: Barajas-Ochoa A; Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA., Hess O; Department of Surgery, Division of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA., Smith T; Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA., Ambrosio M; Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA., Morales M; Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA., Yakubu I; Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia, USA., Thomas L; Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA., Bruno D; Department of Surgery, Division of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia, USA., Vissichelli N; Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA.
Jazyk: angličtina
Zdroj: Transplant infectious disease : an official journal of the Transplantation Society [Transpl Infect Dis] 2024 Dec; Vol. 26 (6), pp. e14387. Date of Electronic Publication: 2024 Oct 05.
DOI: 10.1111/tid.14387
Abstrakt: Introduction: Vancomycin-resistant Enterococci (VRE) infections cause significant morbidity and mortality in liver transplant (LT) recipients. Management is challenging, especially in the setting of daptomycin resistance (DR).
Methods: Single-center retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2022, and developed VRE infections. Descriptive statistics were used and Kaplan-Meier curves estimated freedom from treatment failure and survival.
Results: Forty-two patients (median age 58; 64% female; 67% white) were included. Alcohol-related cirrhosis (48%) and metabolic dysfunction-associated steatohepatitis (31%) were the most common indications for LT, and most were from deceased donors (86%). VRE infection occurred at a median of 21 days after LT, and 16% had known prior VRE colonization. Common infection sites were blood (45%, n = 19), intraabdominal (36%, n = 15), and urine (36%, n = 15). Most were initially treated with daptomycin alone (64%) or in combination with other agents (21%); 7% received linezolid alone. Twelve (29%) developed breakthrough infections during treatment and 11 (26%) had recurrent infections after discontinuation of treatment. All-cause mortality was 36% (n = 15) at a median of 90 days after VRE infection diagnosis and was nearly twice as high in patients with DR (63%).
Conclusion: VRE infection in LT recipients relapsed or recurred in over 25%. Mortality was high, especially in cases with DR. More data is needed to establish an optimal treatment approach, particularly for relapse and DR.
(© 2024 The Author(s). Transplant Infectious Disease published by Wiley Periodicals LLC.)
Databáze: MEDLINE
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