Vancomycin Resistant Enterococcus (VRE) infection is reported in 5-20% of liver transplant (LT) recipients and is associated with decreased survival. Published data includes infections of heterogeneous severity with only a minority of subjects with VRE bacteremia. We sought to determine incidence of enterococcal bacteremia (EB) within 1yr of LT and to compare episodes of VRE to “other” EB. We also determined outcomes and risk factors associated with 30d mortality.

Methods: We retrospectively reviewed records of adult LT recipients 1/1/06-12/31/12 with first blood culture for Enterococcus species within a year after LT. Subjects were grouped as VRE or “other” EB by drug susceptibilities. Risk factors and outcomes were compared for each group. A multivariable logistic model was built to determine the association between selected independent variables and 30d survival after EB.

Results: For 929 patients with LT during the study period, 44 (4.7%) developed EB within 365d. Incidence did not change by year of LT. VRE accounted for 63% of EB. By univariate analysis VRE was associated with ICU admission before transplant (p<0.001) and dialysis after transplant (p=0.024). Compared to other EB, VRE bacteremia occurred earlier (median 16.5 vs 44d), was of longer duration (median 4 vs 3d), resulted in a longer time to effective antibiotic (median 33 vs 10 hr), longer length of stay (median 35 vs 22d), decreased 1yr survival after LT (57.1 vs 75%) and higher 30d mortality (32.1 vs 6.3%; p=0.049). By multivariable analysis, no strong association was identified for 30d mortality by VRE (OR 3.6, p=0.35), linezolid therapy compared to any other antimicrobial therapy (OR 1.2, p=0.84), time to 1^st dose effective antibiotic (OR 1.1, p=0.89), intraabdominal source (OR 1.7, p=0.62) or patient age (OR 3.3, p=0.25) but was associated with dialysis after LT (8.8, p=0.013).

Conclusion: In a large series of VRE bacteremia after LT, incidence of EB was low but represented only a portion of enterococcal infections. VRE bacteremia tended to impact the early transplant course and resulted in high mortality despite use of potent antibiotics. There was no strong data to support the use of linezolid over other active antibiotic in regards to patient outcome. Although the association between VRE bacteremia and survival was not significant, VRE bacteremia resulted in worse outcome compared to other EBs.

CITATION INFORMATION: Odrobina R, Kovacs C, Butler R, Koval C. Characteristics and Outcomes of Vancomycin Resistant Enterococcus Bacteremia After Liver Transplant. Am J Transplant. 2016;16 (suppl 3).

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