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

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2024-10-05 DOI:10.1111/tid.14387

Aldo Barajas-Ochoa, Olivia Hess, Tucker Smith, Matthew Ambrosio, Megan Morales, Idris Yakubu, Lora Thomas, David Bruno, Nicole Vissichelli

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引用次数: 0

Abstract

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.

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单个学术中心肝移植受者耐万古霉素肠球菌和耐达托霉素肠球菌感染的管理。

导言：耐万古霉素肠球菌（VRE）感染在肝移植（LT）受者中造成严重的发病率和死亡率。管理具有挑战性，尤其是在达托霉素耐药（DR）的情况下：单中心回顾性分析 2020 年 1 月 1 日至 2022 年 12 月 31 日期间接受肝移植且发生 VRE 感染的患者。采用描述性统计和卡普兰-梅耶曲线估算治疗失败率和存活率：共纳入 42 名患者（中位年龄 58 岁；64% 为女性；67% 为白人）。酒精相关性肝硬化（48%）和代谢功能障碍相关性脂肪性肝炎（31%）是LT最常见的适应症，大多数患者来自已故供体（86%）。VRE感染发生在LT后的中位数21天，16%的人之前已知有VRE定植。常见感染部位为血液（45%，n = 19）、腹腔内（36%，n = 15）和尿液（36%，n = 15）。大多数患者最初只使用达托霉素（64%）或与其他药物联合使用（21%）；7%的患者只使用利奈唑胺。12例（29%）在治疗过程中出现突破性感染，11例（26%）在停止治疗后出现复发性感染。在确诊VRE感染后的90天内，全因死亡率为36%（n = 15），而DR患者的全因死亡率几乎是后者的两倍（63%）：结论：超过25%的LT受者VRE感染复发或复发。死亡率很高，尤其是在患有 DR 的病例中。需要更多数据来确定最佳治疗方法，尤其是针对复发和DR的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Transplant Infectious Disease 医学-传染病学

CiteScore

5.30

自引率

7.70%

发文量

210

审稿时长

4-8 weeks

期刊介绍： Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal. Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.