Cargando…
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...
Autores principales: | , , , , , , , , , , , |
---|---|
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 |
_version_ | 1784647419141554176 |
---|---|
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. |
format | Online Article Text |
id | pubmed-8826376 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT leerachaela daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT goldmanjason daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT haidarghady daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT lewisjessica daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT arifsana daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT handjonathan daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT lahozricardom daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT pouchstephanie daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT holadayeric daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT claussheather daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT kayekeiths daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation AT nelloreanoma daptomycinresistantenterococcusbacteremiaisassociatedwithpriordaptomycinuseandincreasedmortalityafterlivertransplantation |