Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Dec;26(6):e14387.
doi: 10.1111/tid.14387. Epub 2024 Oct 5.

Management of vancomycin-resistant Enterococci and daptomycin-resistant Enterococci infections in liver transplant recipients in a single academic center

Aldo Barajas-Ochoa  1 , Olivia Hess  2 , Tucker Smith  3 , Matthew Ambrosio  4 , Megan Morales  1 , Idris Yakubu  5 , Lora Thomas  1 , David Bruno  5 , Nicole Vissichelli  1
Affiliations

Management of vancomycin-resistant Enterococci and daptomycin-resistant Enterococci infections in liver transplant recipients in a single academic center

Aldo Barajas-Ochoa et al. Transpl Infect Dis. 2024 Dec.

Abstract

Introduction: Vancomycin-resistant Enterococci (VRE) infections cause significant morbidity and mortality in liver transplant (LT) recipients. Management is challenging, especially in the setting of daptomycin resistance (DR).

Methods: Single-center retrospective review of patients who underwent LT between January 1, 2020, and December 31, 2022, and developed VRE infections. Descriptive statistics were used and Kaplan-Meier curves estimated freedom from treatment failure and survival.

Results: Forty-two patients (median age 58; 64% female; 67% white) were included. Alcohol-related cirrhosis (48%) and metabolic dysfunction-associated steatohepatitis (31%) were the most common indications for LT, and most were from deceased donors (86%). VRE infection occurred at a median of 21 days after LT, and 16% had known prior VRE colonization. Common infection sites were blood (45%, n = 19), intraabdominal (36%, n = 15), and urine (36%, n = 15). Most were initially treated with daptomycin alone (64%) or in combination with other agents (21%); 7% received linezolid alone. Twelve (29%) developed breakthrough infections during treatment and 11 (26%) had recurrent infections after discontinuation of treatment. All-cause mortality was 36% (n = 15) at a median of 90 days after VRE infection diagnosis and was nearly twice as high in patients with DR (63%).

Conclusion: VRE infection in LT recipients relapsed or recurred in over 25%. Mortality was high, especially in cases with DR. More data is needed to establish an optimal treatment approach, particularly for relapse and DR.

Keywords: eravacycline; liver transplant; vancomycin‐resistant Enterococci.

PubMed Disclaimer

Conflict of interest statement

Megan Morales was a paid speaker for Karius, Inc. and a consultant for Cidara Therapeutics. Nicole Vissichelli was a paid speaker for Karius, Inc. Idris Yakubu was a paid speaker for Veloxis Pharmaceuticals and Takeda Pharmaceuticals. The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
(A) Freedom of treatment failure. Freedom of treatment failure for the overall cohort and subgroups for those with urinary tract infections, intraabdominal infections, and bloodstream infections determined. (B) Survival after vancomycin‐resistant Enterococci (VRE) infections. Survival curves for the entire cohort as well as the subgroups that were diagnosed with breakthrough, recurrent, and daptomycin‐resistant infections from the time of diagnosis of infection due to vancomycin‐resistant Enterococci.
See this image and copyright information in PMC

References

    1. Hernandez MDP, Martin P, Simkins J. Infectious complications after liver transplantation. Gastroenterol Hepatol. 2015;11(11):741‐753. - PMC - PubMed
    1. Nellore A, Huprikar S; AST ID Community of Practice . Vancomycin‐resistant enterococcus in solid organ transplant recipients: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13549. doi:10.1111/ctr.13549 - DOI - PubMed
    1. Khan A, Miller WR, Axell‐House D, Munita JM, Arias CA. Antimicrobial susceptibility testing for Enterococci . J Clin Microbiol. 2022;60(9):e0084321. doi:10.1128/jcm.00843-21 - DOI - PMC - PubMed
    1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435‐1486. doi:10.1161/CIR.0000000000000296 - DOI - PubMed
    1. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948‐4042. doi:10.1093/eurheartj/ehad193 - DOI - PubMed

MeSH terms