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Daptomycin perioperative prophylaxis for the prevention of vancomycin‐resistant Enterococcus infection in colonized liver transplant recipients
Author(s) -
Sarwar Sajed,
Koff Alan,
Malinis Maricar,
Azar Marwan M.
Publication year - 2020
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13280
Subject(s) - medicine , daptomycin , vancomycin resistant enterococcus , perioperative , liver transplantation , bacteremia , enterococcus , transplantation , antibiotics , vancomycin , surgery , staphylococcus aureus , microbiology and biotechnology , biology , bacteria , genetics
Background Vancomycin‐resistant Enterococcus (VRE)‐colonized liver transplantation (LT) recipients have increased post‐LT morbidity, mortality, and higher rates of VRE infections compared with their non‐colonized counterparts. Pre‐LT screening for VRE colonization and inclusion of daptomycin in the perioperative antibiotic prophylaxis regimen may mitigate this risk. Methods We performed a retrospective chart review of liver transplant recipients aged ≥ 18 years between 2013 and August 2019 to identify pre‐LT VRE‐colonized recipients and whether they received daptomycin perioperative prophylaxis (DPP). Demographic and clinical characteristics, including risk factors for VRE infection, were collected. Outcomes measured were VRE‐related infection and all‐cause mortality within 90 days of LT. Results Of the 27 VRE‐colonized liver transplant recipients within the study period, 25 received DPP. All recipients were admitted to the intensive care unit postoperatively, six (24%) required reoperation, fifteen (60%) required renal replacement therapy, and eight (32%) experienced postoperative hemorrhage within 90 days post‐transplant. Two recipients (8%) experienced acute cellular rejection, but no primary graft failure was seen within 90 days. Among those who received DPP, no infections related to VRE or death was seen within 90 days of LT. The two VRE‐colonized recipients who did not receive DPP both developed VRE bacteremia in the early post‐LT period. Conclusion Despite having multiple risk factors for post‐LT VRE infection, VRE‐colonized recipients who received DPP did not develop VRE‐related infections in the first 90 days post‐LT. Our experience demonstrates that pre‐LT VRE screening and DPP may be associated with a reduction in VRE infection in the early post‐LT period, but this strategy warrants further evaluation in prospective studies.