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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 SOFA Non-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 ).

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