Abstract
BackgroundThe relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT).MethodsThe outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycin-susceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days.ResultsMortality was similar between VRE- (n = 39) and VSE- (n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFANon-GCS score during the 7-day-period before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14–1.53; and HR 1.18; CI 1.08–1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders.ConclusionVancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population.Trial registrationThis study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).
Highlights
The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial
During the 11-year observation period, we identified a total of 1250 patients with E. faecium BSI in our study centre; 177 of them were adult liver transplant recipients and were included in the final analysis (Fig. 1)
Age and Model for End-stage Liver Disease (MELD) scores at orthotopic liver transplantation (OLT) were comparable between the vancomycin-resistant enterococci (VRE) and vancomycinsusceptible Enterococcus faecium (VSE) group
Summary
The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT). Enterococci were considered to be harmless inhabitants of the human gastrointestinal tract, only rarely causing opportunistic infections in critically ill patients. They have been studied to be among leading pathogens of nosocomial infections, and they are a major international health burden [1,2,3]. Treatment of enterococcal blood stream infections has become more difficult due to the increase of multidrug resistance. The independent impact of this increasing vancomycin resistance on patients’ outcome is still
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