Colonization by Vancomycin-Resistant Enterococci in Liver Transplantation: Risk Factors and Survival Impact.

IF 2.6 4区医学 Q3 IMMUNOLOGY

Transplant Infectious Disease Pub Date : 2025-07-22 DOI:10.1111/tid.70072

Nathalia Neves Nunes, Lohayne Alves Ferreira, Fernanda Spadão, Alice Tung Wan Song, Debora Raquel Benedita Terrabuio, Luiz Augusto Carneiro D'Albuquerque, Edson Abdala, Maristela Pinheiro Freire

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引用次数: 0

Abstract

Background: Vancomycin-resistant enterococci (VRE) are multidrug-resistant microorganisms (MDRO) commonly isolated in liver transplant recipients and potentially associated with worse outcomes. We aimed to identify risk factors associated with VRE colonization in liver transplantation (LT) and its impact on posttransplant survival.

Methods: This is a retrospective cohort that included all adults who underwent LT between 2010 and 2022 at a tertiary-level hospital in São Paulo, Brazil. Multivariate analyses were performed using logistic regression for VRE colonization risk and Cox regression for 180-day survival.

Results: A total of 1209 patients were included, 119 patients (9.8%) were colonized with VRE at LT, while 175 (14.5%) were colonized after LT, 77 (6.4%) patients developed VRE infection after LT. In the multivariate analysis, use of SBP prophylaxis, presence of acute-on-chronic liver failure, hepatitis B virus infection, ASA score, length of hospital stay and MELD score were all associated with VRE colonization before LT. For VRE colonization after LT, the predictors were length of hospital stay before LT, MELD score, carbapenem-resistant Gram-negative colonization, intraoperative bleeding and re-transplantation. Note that 180-day mortality rate among VRE colonization and infection was, respectively, 33.6% and 50.6% compared to 17.8% of non-colonized patients, and this difference was not statistically significant after adjustment for confounders in multivariate analysis.

Conclusion: VRE colonization or infection had no impact on survival in a large cohort of liver transplantrecipients.

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万古霉素耐药肠球菌在肝移植中的定植：危险因素和生存影响。

背景：万古霉素耐药肠球菌（VRE）是一种多药耐药微生物（MDRO），通常在肝移植受者中分离出来，可能与较差的预后相关。我们旨在确定与肝移植（LT）中VRE定植相关的危险因素及其对移植后生存的影响。方法：这是一项回顾性队列研究，包括2010年至2022年在巴西圣保罗一家三级医院接受肝移植的所有成年人。采用logistic回归对VRE定植风险进行多因素分析，并对180天生存率进行Cox回归。结果:共纳入1209例患者，LT时有119例（9.8%）定植VRE， LT后有175例（14.5%）定植VRE， LT后有77例（6.4%）发生VRE感染。在多因素分析中，使用收缩压预防、存在急性慢性肝功能衰竭、乙型肝炎病毒感染、ASA评分、住院时间和MELD评分均与LT前VRE定植相关。预测因子为肝移植前住院时间、MELD评分、耐碳青霉烯革兰氏阴性定植、术中出血和再移植。值得注意的是，VRE定植和感染的180天死亡率分别为33.6%和50.6%，而未定植的患者为17.8%，在多变量分析中调整混杂因素后，这一差异无统计学意义。结论：VRE定植或感染对大量肝移植受者的生存无影响。

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.