Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study
: Background: Liver transplant recipients are at high risk for multi‐drug resistant infections because of broad‐spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients. Methods: Liv...
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| Veröffentlicht in: | Clinical transplantation 2005-12, Vol.19 (6), p.711-716 |
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| creator | Gearhart, Michelle Martin, Jill Rudich, Steve Thomas, Mark Wetzel, Dave Solomkin, Joseph Hanaway, Michael J Aranda-Michel, Jaime Weber, Fred Trumball, Leslie Bass, Maryetta Zavala, Ed Steve Woodle, E Buell, Joseph F |
| description | : Background: Liver transplant recipients are at high risk for multi‐drug resistant infections because of broad‐spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients.
Methods: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co‐infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls.
Results: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty‐eight non‐VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4–348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non‐VRE group (95% vs. 34%; p |
| doi_str_mv | 10.1111/j.1399-0012.2005.00362.x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_68838210</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>68838210</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4652-9c1f2dd0a4a3f4a4389c91c46375405618fac436ac9cf86563b30090ada252f93</originalsourceid><addsrcrecordid>eNqNkUtv1DAUhS0EokPhLyBvYJfgR-KxERsUlfKoQILy2FnujSM8JPbUdsrMv8dhRu0SvLHl-x373nMQwpTUtKwXm5pypSpCKKsZIW1NCBes3t1Dq9vCfbQiirByFvwEPUppU24FFe1DdEIFp5zTZoVcF3yy17P1YBMOA74xHsK0B-eraJNL2fiMz3y2MUAAmBN2Ho_uxkaco_FpOy5AtOC2zvqcXmKDJ5Php-0xBJ9jGHHKc79_jB4MZkz2yXE_RV_fnF12b6uLT-fvutcXFTSiZZUCOrC-J6YxfGhMw6UCRUuNr9uGtILKwUDDhQEFgxSt4FeclEFNb1jLBsVP0fPDu9sYylwp68klsGPp04Y5aSEll4ySf4JUMSk4bwsoDyDEkFK0g95GN5m415ToJQ-90YvterFdL3nov3noXZE-Pf4xX022vxMeAyjAsyNgEphxKJaCS3fcmq0Z5Uuzrw7cbzfa_X83oLvLz-VQ5NVBXgK1u1u5ib-0WBdn9feP5_rDt_dffsiu0ZL_AY49tgU</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>19286335</pqid></control><display><type>article</type><title>Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><creator>Gearhart, Michelle ; Martin, Jill ; Rudich, Steve ; Thomas, Mark ; Wetzel, Dave ; Solomkin, Joseph ; Hanaway, Michael J ; Aranda-Michel, Jaime ; Weber, Fred ; Trumball, Leslie ; Bass, Maryetta ; Zavala, Ed ; Steve Woodle, E ; Buell, Joseph F</creator><creatorcontrib>Gearhart, Michelle ; Martin, Jill ; Rudich, Steve ; Thomas, Mark ; Wetzel, Dave ; Solomkin, Joseph ; Hanaway, Michael J ; Aranda-Michel, Jaime ; Weber, Fred ; Trumball, Leslie ; Bass, Maryetta ; Zavala, Ed ; Steve Woodle, E ; Buell, Joseph F</creatorcontrib><description>: Background: Liver transplant recipients are at high risk for multi‐drug resistant infections because of broad‐spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients.
Methods: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co‐infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls.
Results: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty‐eight non‐VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4–348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non‐VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group ($6500 vs. 1750; p = 0.02) as well.
Conclusion: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non‐VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.</description><identifier>ISSN: 0902-0063</identifier><identifier>EISSN: 1399-0012</identifier><identifier>DOI: 10.1111/j.1399-0012.2005.00362.x</identifier><identifier>PMID: 16313314</identifier><language>eng</language><publisher>Oxford, UK: Munksgaard International Publishers</publisher><subject>Biological and medical sciences ; Enterococcus ; Enterococcus - drug effects ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Gram-Positive Bacterial Infections - epidemiology ; Humans ; Incidence ; Length of Stay ; Liver - microbiology ; liver transplant ; Liver Transplantation - immunology ; Male ; Matched-Pair Analysis ; Medical sciences ; Middle Aged ; Retrospective Studies ; Risk Factors ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tissue, organ and graft immunology ; vancomycin ; Vancomycin Resistance ; vancomycin-resistant Enterococcus</subject><ispartof>Clinical transplantation, 2005-12, Vol.19 (6), p.711-716</ispartof><rights>2006 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4652-9c1f2dd0a4a3f4a4389c91c46375405618fac436ac9cf86563b30090ada252f93</citedby><cites>FETCH-LOGICAL-c4652-9c1f2dd0a4a3f4a4389c91c46375405618fac436ac9cf86563b30090ada252f93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-0012.2005.00362.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-0012.2005.00362.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17272130$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16313314$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gearhart, Michelle</creatorcontrib><creatorcontrib>Martin, Jill</creatorcontrib><creatorcontrib>Rudich, Steve</creatorcontrib><creatorcontrib>Thomas, Mark</creatorcontrib><creatorcontrib>Wetzel, Dave</creatorcontrib><creatorcontrib>Solomkin, Joseph</creatorcontrib><creatorcontrib>Hanaway, Michael J</creatorcontrib><creatorcontrib>Aranda-Michel, Jaime</creatorcontrib><creatorcontrib>Weber, Fred</creatorcontrib><creatorcontrib>Trumball, Leslie</creatorcontrib><creatorcontrib>Bass, Maryetta</creatorcontrib><creatorcontrib>Zavala, Ed</creatorcontrib><creatorcontrib>Steve Woodle, E</creatorcontrib><creatorcontrib>Buell, Joseph F</creatorcontrib><title>Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study</title><title>Clinical transplantation</title><addtitle>Clin Transplant</addtitle><description>: Background: Liver transplant recipients are at high risk for multi‐drug resistant infections because of broad‐spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients.
Methods: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co‐infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls.
Results: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty‐eight non‐VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4–348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non‐VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group ($6500 vs. 1750; p = 0.02) as well.
Conclusion: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non‐VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.</description><subject>Biological and medical sciences</subject><subject>Enterococcus</subject><subject>Enterococcus - drug effects</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Gram-Positive Bacterial Infections - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Length of Stay</subject><subject>Liver - microbiology</subject><subject>liver transplant</subject><subject>Liver Transplantation - immunology</subject><subject>Male</subject><subject>Matched-Pair Analysis</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tissue, organ and graft immunology</subject><subject>vancomycin</subject><subject>Vancomycin Resistance</subject><subject>vancomycin-resistant Enterococcus</subject><issn>0902-0063</issn><issn>1399-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkUtv1DAUhS0EokPhLyBvYJfgR-KxERsUlfKoQILy2FnujSM8JPbUdsrMv8dhRu0SvLHl-x373nMQwpTUtKwXm5pypSpCKKsZIW1NCBes3t1Dq9vCfbQiirByFvwEPUppU24FFe1DdEIFp5zTZoVcF3yy17P1YBMOA74xHsK0B-eraJNL2fiMz3y2MUAAmBN2Ho_uxkaco_FpOy5AtOC2zvqcXmKDJ5Php-0xBJ9jGHHKc79_jB4MZkz2yXE_RV_fnF12b6uLT-fvutcXFTSiZZUCOrC-J6YxfGhMw6UCRUuNr9uGtILKwUDDhQEFgxSt4FeclEFNb1jLBsVP0fPDu9sYylwp68klsGPp04Y5aSEll4ySf4JUMSk4bwsoDyDEkFK0g95GN5m415ToJQ-90YvterFdL3nov3noXZE-Pf4xX022vxMeAyjAsyNgEphxKJaCS3fcmq0Z5Uuzrw7cbzfa_X83oLvLz-VQ5NVBXgK1u1u5ib-0WBdn9feP5_rDt_dffsiu0ZL_AY49tgU</recordid><startdate>200512</startdate><enddate>200512</enddate><creator>Gearhart, Michelle</creator><creator>Martin, Jill</creator><creator>Rudich, Steve</creator><creator>Thomas, Mark</creator><creator>Wetzel, Dave</creator><creator>Solomkin, Joseph</creator><creator>Hanaway, Michael J</creator><creator>Aranda-Michel, Jaime</creator><creator>Weber, Fred</creator><creator>Trumball, Leslie</creator><creator>Bass, Maryetta</creator><creator>Zavala, Ed</creator><creator>Steve Woodle, E</creator><creator>Buell, Joseph F</creator><general>Munksgaard International Publishers</general><general>Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>200512</creationdate><title>Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study</title><author>Gearhart, Michelle ; Martin, Jill ; Rudich, Steve ; Thomas, Mark ; Wetzel, Dave ; Solomkin, Joseph ; Hanaway, Michael J ; Aranda-Michel, Jaime ; Weber, Fred ; Trumball, Leslie ; Bass, Maryetta ; Zavala, Ed ; Steve Woodle, E ; Buell, Joseph F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4652-9c1f2dd0a4a3f4a4389c91c46375405618fac436ac9cf86563b30090ada252f93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Biological and medical sciences</topic><topic>Enterococcus</topic><topic>Enterococcus - drug effects</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Gram-Positive Bacterial Infections - epidemiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Length of Stay</topic><topic>Liver - microbiology</topic><topic>liver transplant</topic><topic>Liver Transplantation - immunology</topic><topic>Male</topic><topic>Matched-Pair Analysis</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tissue, organ and graft immunology</topic><topic>vancomycin</topic><topic>Vancomycin Resistance</topic><topic>vancomycin-resistant Enterococcus</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gearhart, Michelle</creatorcontrib><creatorcontrib>Martin, Jill</creatorcontrib><creatorcontrib>Rudich, Steve</creatorcontrib><creatorcontrib>Thomas, Mark</creatorcontrib><creatorcontrib>Wetzel, Dave</creatorcontrib><creatorcontrib>Solomkin, Joseph</creatorcontrib><creatorcontrib>Hanaway, Michael J</creatorcontrib><creatorcontrib>Aranda-Michel, Jaime</creatorcontrib><creatorcontrib>Weber, Fred</creatorcontrib><creatorcontrib>Trumball, Leslie</creatorcontrib><creatorcontrib>Bass, Maryetta</creatorcontrib><creatorcontrib>Zavala, Ed</creatorcontrib><creatorcontrib>Steve Woodle, E</creatorcontrib><creatorcontrib>Buell, Joseph F</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gearhart, Michelle</au><au>Martin, Jill</au><au>Rudich, Steve</au><au>Thomas, Mark</au><au>Wetzel, Dave</au><au>Solomkin, Joseph</au><au>Hanaway, Michael J</au><au>Aranda-Michel, Jaime</au><au>Weber, Fred</au><au>Trumball, Leslie</au><au>Bass, Maryetta</au><au>Zavala, Ed</au><au>Steve Woodle, E</au><au>Buell, Joseph F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study</atitle><jtitle>Clinical transplantation</jtitle><addtitle>Clin Transplant</addtitle><date>2005-12</date><risdate>2005</risdate><volume>19</volume><issue>6</issue><spage>711</spage><epage>716</epage><pages>711-716</pages><issn>0902-0063</issn><eissn>1399-0012</eissn><abstract>: Background: Liver transplant recipients are at high risk for multi‐drug resistant infections because of broad‐spectrum antibiotic and immunosuppression. This study evaluates the clinical and financial impact of vancomycin resistant Enterococcus (VRE) in liver transplant recipients.
Methods: Liver transplant recipients with VRE from 1995 to 2002 were identified and matched (age, gender, UNOS status, liver disease and transplant date) to controls. Demographics, clinical factors, co‐infections, antibiotic use, length of stay, abdominal surgeries, biliary complications, survival and resource utilization were compared with matched controls.
Results: Nineteen patients were found to have 28 VRE infections via evaluation of microbiologic culture results of all liver transplant patients in the transplant registry. Thirty‐eight non‐VRE patients served as matched controls. The four most common sites VRE was cultured from included blood (35%), peritoneal fluid (35%), bile (20%), and urine (12%). Median time from transplant to infection was 48 d (range of 4–348). No significant differences in demographics were observed. The VRE group had a higher incidence of prior antibiotic use than the non‐VRE group (95% vs. 34%; p < 0.05). The VRE group also experienced more abdominal surgery (20/19 vs. 3/38; p = 0.029), biliary complications (9/19 vs. 9/38; p = 0.018) and a longer length of stay (42.5 vs. 21.7 d; p = .005). Survival in the VRE group was lower (52% vs. 82%; p = 0.048). Six of the 19 VRE patients were treated with linezolid for eight infection episodes, and four of six patients survived. Eight patients were treated with quinupristin/dalfopristin for nine infections, and two of eight survived. Increased cost of care was observed in the VRE group. Laboratory costs were higher in the VRE group ($6500 vs. 1750; p = 0.02) as well.
Conclusion: VRE was associated with prior antibiotic use, multiple abdominal surgeries, biliary complications and resulted in decreased survival compared to non‐VRE control patients. VRE patients also utilized more hospital resources. Linezolid showed a trend toward improved survival.</abstract><cop>Oxford, UK</cop><pub>Munksgaard International Publishers</pub><pmid>16313314</pmid><doi>10.1111/j.1399-0012.2005.00362.x</doi><tpages>6</tpages></addata></record> |
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| subjects | Biological and medical sciences Enterococcus Enterococcus - drug effects Female Fundamental and applied biological sciences. Psychology Fundamental immunology Gram-Positive Bacterial Infections - epidemiology Humans Incidence Length of Stay Liver - microbiology liver transplant Liver Transplantation - immunology Male Matched-Pair Analysis Medical sciences Middle Aged Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissue, organ and graft immunology vancomycin Vancomycin Resistance vancomycin-resistant Enterococcus |
| title | Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: a matched control study |
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