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Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

BACKGROUND: Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transpla...

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Autores principales: Lee, Rachael A, Goldman, Jason, Haidar, Ghady, Lewis, Jessica, Arif, Sana, Hand, Jonathan, La Hoz, Ricardo M, Pouch, Stephanie, Holaday, Eric, Clauss, Heather, Kaye, Keith S, Nellore, Anoma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826376/
https://www.ncbi.nlm.nih.gov/pubmed/35146044
http://dx.doi.org/10.1093/ofid/ofab659
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author Lee, Rachael A
Goldman, Jason
Haidar, Ghady
Lewis, Jessica
Arif, Sana
Hand, Jonathan
La Hoz, Ricardo M
Pouch, Stephanie
Holaday, Eric
Clauss, Heather
Kaye, Keith S
Nellore, Anoma
author_facet Lee, Rachael A
Goldman, Jason
Haidar, Ghady
Lewis, Jessica
Arif, Sana
Hand, Jonathan
La Hoz, Ricardo M
Pouch, Stephanie
Holaday, Eric
Clauss, Heather
Kaye, Keith S
Nellore, Anoma
author_sort Lee, Rachael A
collection PubMed
description BACKGROUND: Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact of daptomycin-resistant Enterococcus (DRE) in this patient population. METHODS: We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within 1 year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. RESULTS: We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total intensive care unit days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within 1 year of transplantation (adjusted odds ratio [aOR], 2.648; 95% CI, 1.025–6.840; P = .044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR, 30.62; 95% CI, 10.087–92.955; P < .001). CONCLUSIONS: In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared with VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia.
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spelling pubmed-88263762022-02-09 Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation Lee, Rachael A Goldman, Jason Haidar, Ghady Lewis, Jessica Arif, Sana Hand, Jonathan La Hoz, Ricardo M Pouch, Stephanie Holaday, Eric Clauss, Heather Kaye, Keith S Nellore, Anoma Open Forum Infect Dis Major Article BACKGROUND: Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact of daptomycin-resistant Enterococcus (DRE) in this patient population. METHODS: We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within 1 year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. RESULTS: We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total intensive care unit days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within 1 year of transplantation (adjusted odds ratio [aOR], 2.648; 95% CI, 1.025–6.840; P = .044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR, 30.62; 95% CI, 10.087–92.955; P < .001). CONCLUSIONS: In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared with VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia. Oxford University Press 2022-01-22 /pmc/articles/PMC8826376/ /pubmed/35146044 http://dx.doi.org/10.1093/ofid/ofab659 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Major Article
Lee, Rachael A
Goldman, Jason
Haidar, Ghady
Lewis, Jessica
Arif, Sana
Hand, Jonathan
La Hoz, Ricardo M
Pouch, Stephanie
Holaday, Eric
Clauss, Heather
Kaye, Keith S
Nellore, Anoma
Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title_full Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title_fullStr Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title_full_unstemmed Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title_short Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation
title_sort daptomycin-resistant enterococcus bacteremia is associated with prior daptomycin use and increased mortality after liver transplantation
topic Major Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8826376/
https://www.ncbi.nlm.nih.gov/pubmed/35146044
http://dx.doi.org/10.1093/ofid/ofab659
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