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. 2020 Jan 31;9(1):22.
doi: 10.1186/s13756-020-0683-3.

Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

S Dubler  1 , M Lenz  2   3 , S Zimmermann  4 , D C Richter  2 , K H Weiss  5 , A Mehrabi  6 , M Mieth  6 , T Bruckner  7 , M A Weigand  2 , T Brenner  2 , A Heininger  8
Affiliations

Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

S Dubler et al. Antimicrob Resist Infect Control. .

Abstract

Background: 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).

Methods: The 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.

Results: Mortality 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.

Conclusion: Vancomycin 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 registration: This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).

Keywords: Bacteraemia; Enterococci; Liver transplantation; Mortality; Vancomycin resistance.

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Conflict of interest statement

Karl-Heinz Weiss advises for Alexion, Univar, GMP-O, Ipsen, Chiesi, Novartis. Karl-Heinz Weiss is on the speaker’s bureau of Pfizer, Abbvie, Eisai. Karl-Heinz Weiss received grant support (to the institution) from AstraZenica, QED, Novartis, Univar, Alexion and GMP-O. Markus Weigand is on the advisory boards from MSD, Gilead, Pfizer, Shionogi. Thorsten Brenner received research funding from German Research Foundation (DFG), Heidelberg Foundation of Surgery, Dietmar Hopp Foundation. Thorsten Brenner received honoraria for lectures and advisory boards from: Biotest AG, Baxter Deutschland GmbH, Schöchl medical education GmbH, Boehringer Ingelheim Pharma GmbH, CSL Behring GmbH, Astellas Pharma GmbH, B. Braun Melsungen AG, MSD Sharp & Dohme GmbH. Alexandra Heininger received speaker honorary by MSD and Pfizer. Simon Dubler, Martin Lenz, Stefan Zimmermann, Daniel Richter, Arianeb Mehrabi, Markus Mieth and Thomas Brucker declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for this study. Abbreviations: OLT, orthotopic liver transplantation; BSI, blood stream infection; VRE, vancomycin-resistant Enterococcus faecium; VSE, vancomycin-susceptible E. faecium
Fig. 2
Fig. 2
Kaplan-Meier survival curves after bloodstream infections with vancomycin-resistant E. faecium (VRE) versus vancomycin-susceptible E. faecium (VSE) following orthotopic liver transplantation (OLT). Data were adjusted for confounders
See this image and copyright information in PMC

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