Background: Enterococci are one of the leading causes of nosocomial infection in after OLT. Unfortunately, treatment options for enterococci that are resistant to first-line agents are limited and microbial clearance in immunocompromised patients can be difficult. Daptomycin is an excellent in vitro activity against enterococci, including vancomycin resistant enterococci (VRE). However, data regarding the use of daptomycin for treatment of VRE in the OLT population are limited.

Methods: Via the AST ID COP, a multi-center retrospective study of VRE bacteremic OLT recipients was conducted from 2005-2016. Factors examined include demographics, donor type, immunosuppression and surgical complications as well as blood VRE isolate characteristics including MIC of daptomycin, agent used to treat isolate, isolate recurrence and prior exposure to daptomycin. Primary outcomes were graft loss and death.

Results: Seven sites participated and 120 VRE bacteremic OLT recipients were identified. Subjects were stratified into cohorts according to daptomycin MIC of initial VRE blood isolate: (1) MIC<2 [micro]g/ml (N=20), (2) MIC 2-4 [micro]g/ml (N=74) or (3) MIC>4 [micro]g/ml (N=26) i.e. daptomycin non-susceptible enterococci (DNSE). Among the 3 cohorts, there were no significant differences in age at transplant, race, ESLD diagnosis, natural MELD at time of transplant, or antecedent surgical complication and rejection rates. In comparison to cohorts (1) and (2), subjects with DNSE bacteremia had significantly increased rates of prior daptomycin exposure (p=0.04), recurrent VRE bacteremia (p<0.001), and death censored allograft failure (p=0.008).

Conclusion: DNSE bacteremia in OLT is associated with increased rates of graft failure and prior daptomycin exposure. These data underscore the importance of antimicrobial stewardship in the treatment of enterococcal infections in the liver transplant population.

CITATION INFORMATION: Lee R., Haidar G., Lewis J., Arif S., Hand J., Holaday E., Clauss H., Goldman J., Nellore A. Daptomycin Minimum Inhibitory Concentration (MIC) of Vancomycin Resistant Enterococcal (VRE) Blood Isolates Correlates with Allograft Failure in Orthotopic Liver Transplant (OLT) Recipients Am J Transplant. 2017;17 (suppl 3).

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