Impact of VRE-active perioperative prophylaxis in liver transplant patients colonized by Vancomycin-Resistant Enterococci.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases Pub Date : 2025-03-14 DOI:10.1093/cid/ciaf121

Giulia Jole Burastero, Emmanuel Q Wey, Veronica Guidetti, Samuele Cantergiani, Valentina Menozzi, Davide Lo Porto, Andrea Cona, Amreen Khan, Valentina Serra, Giacomo Assirati, Giovanni Guaraldi, Giovanni Dolci, Marianna Meschiari, Adriana Cervo, Martina Tosi, Salvatore Gruttadauria, Joerg-Matthias Pollok, Fabrizio Di Benedetto, Alessandra Mularoni, Cristina Mussini, Erica Franceschini

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引用次数: 0

Abstract

Background: Data regarding the effectiveness of vancomycin resistant Enterococci (VRE) active prophylaxis for preventing early post-liver transplant (LT) VRE infections in VRE-colonized patients are scarce.

Methods: One-hundred-thirty-one pre-LT VRE colonized patients who underwent liver transplantation were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.

Results: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69, 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active vs non-VRE-active groups at 7 [0 (0.0 %) vs 2 (3.2 %), p=0.222], 14 [4 (5.7 %) vs 4 (6.4%), p=1.000] and 30 [6 (8.7%) vs. 8 (12.9%), p=0.621] days post-LT respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank p=0.16 at Kaplan-Meier analysis; OR 0.643, 95% CI 0.210-1.969, p=0.439 at univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared to the control group [11 (15.9%) vs. 20 (32.2%), p=0.047]. Tigecycline prophylaxis was associated with a lower risk of early-onset infections at multivariate analysis (OR 0.106, 95% CI 0.015-0.745, p=0.024) and after adjusting for propensity score (aOR 0.146, 95% CI 0.031-0.708, p=0.017).

Conclusions: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.

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耐万古霉素肠球菌定植的肝移植患者围手术期使用 VRE 活性预防药物的影响。

背景：有关耐万古霉素肠球菌（VRE）的积极预防措施对预防肝移植（LT）后VRE定植患者早期VRE感染的有效性的数据很少：一项回顾性、观察性、多中心研究共纳入了 131 名接受肝移植手术的 LT 前 VRE 定植患者。结果：69 例（52.7%）肝移植前 VRE 定植患者感染了 VRE：69名（52.7%）和62名（47.3%）患者分别加入了VRE主动预防组和非VRE主动预防组。替加环素是最常见的VRE活性预防药物（55/69，79.7%）。在 LT 后 7 天 [0 (0.0 %) vs 2 (3.2 %)，p=0.222]、14 天 [4 (5.7 %) vs 4 (6.4 %)，p=1.000]和 30 天 [6 (8.7 %) vs. 8 (12.9 %)，p=0.621]，VRE 活性组和非 VRE 活性组发生早发 VRE 感染的患者人数无明显差异。VRE活跃组在30天内发生早期VRE感染的风险并不低（卡普兰-梅耶分析的对数秩p=0.16；单变量分析的OR为0.643，95% CI为0.210-1.969，p=0.439）。相反，与对照组相比，VRE 活性预防组中由任何病原体引起的早期感染显著减少 [11 (15.9%) vs. 20 (32.2%)，p=0.047]。在多变量分析（OR 0.106，95% CI 0.015-0.745，p=0.024）和倾向评分调整后（aOR 0.146，95% CI 0.031-0.708，p=0.017），替加环素预防与较低的早发感染风险相关：结论：在LT时进行VRE活性预防并不能降低LT后早期VRE感染的发生率，因此不应推荐使用。

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

Clinical Infectious Diseases 医学-传染病学

CiteScore

25.00

自引率

2.50%

发文量

900

审稿时长

3 months

期刊介绍： Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.