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Outcomes of Colonization with MRSA and VRE Among Liver Transplant Candidates and Recipients
Author(s) -
Russell D. L.,
Flood A.,
Zaroda T. E.,
Acosta C.,
Riley M. M. S.,
Busuttil R. W.,
Pegues D. A.
Publication year - 2008
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2008.02304.x
Subject(s) - medicine , colonization , methicillin resistant staphylococcus aureus , vancomycin resistant enterococcus , population , logistic regression , proportional hazards model , enterococcus , staphylococcus aureus , vancomycin , antibiotics , microbiology and biotechnology , biology , genetics , environmental health , bacteria
Methicillin‐resistant Staphylococcus aureus (MRSA) and vancomycin‐resistant enterococcus (VRE) infections cause significant morbidity and mortality among liver transplant candidates and recipients. To assess rates of MRSA and VRE colonization, we obtained active surveillance cultures from 706 liver transplant candidates and recipients within 24 h of admission to an 11‐bed liver transplant ICU from October 2000 to December 2005. Patients were followed prospectively to determine the cumulative risk of MRSA or VRE infection or death by colonization status. Outcomes were assessed by Kaplan–Meier survival analysis and Cox regression and multivariate logistic regression adjusting for covariates. The prevalence of newly detected MRSA nasal and VRE rectal colonization was 6.7% and 14.6%, respectively. Liver transplant candidates and recipients with MRSA colonization had an increased risk of MRSA infection (adjusted OR = 15.64, 95% CI 6.63–36.89) but not of death (adjusted OR = 1.00, 95% CI 0.43–2.30), whereas those with VRE colonization had an increased risk both of VRE infection (adjusted OR = 3.61, 95% CI 2.01–6.47) and of death (adjusted OR = 2.12, 95% CI 1.27–3.54) compared with noncolonized patients. Prevention and control strategies, including use of active surveillance cultures, should be implemented to reduce the rates of both MRSA and VRE colonization in this high‐risk patient population.