Daptomycin-Resistant Enterococcus Bacteremia Is Associated With Prior Daptomycin Use and Increased Mortality After Liver Transplantation

• Type of Material: Article
• Authors: Rachael A Lee, University of Alabama Birmingham; Jason Goldman, Swedish Med Ctr; Ghady Haidar, University of Pittsburgh; Jessica Lewis, Medical University of South Carolina; Sana Arif, Duke University; Jonathan Hand, Oschner Health; Ricardo M La Hoz, University of Texas Southwestern Medical Center; Stephanie Pouch, Emory University; Eric Holaday, Temple University; Heather Clauss, Temple University; Keith S Kaye, University of Michigan; Anoma Nellore, University of Alabama Birmingham
• Language: English
• Date: 2022-03-01
• Publisher: OXFORD UNIV PRESS INC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofab659
• Title of Journal or Parent Work: OPEN FORUM INFECTIOUS DISEASES
• Volume: 9
• Issue: 3
• Start Page: ofab659
• End Page: ofab659
• Grant/Funding Information: None.
• Keywords: Immunology; COLONIZATION; RISK-FACTORS; BLOOD-STREAM INFECTIONS; DE-NOVO; Enterococcus; SUSCEPTIBILITY; SOLID-ORGAN TRANSPLANTATION; VANCOMYCIN; EPIDEMIOLOGY; Infectious Diseases; Life Sciences & Biomedicine; daptomycin; liver transplant; bacteremia; CLINICAL-OUTCOMES; Science & Technology; FAECIUM; Microbiology
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Risk factors for acquisition of vancomycin-resistant Enterococcus (VRE) include immunosuppression, antibiotic exposure, indwelling catheters, and manipulation of the gastrointestinal tract, all of which occur in liver transplant recipients. VRE infections are documented in liver transplantation (LT); however, only one single center study has assessed the impact of daptomycin-resistant Enterococcus (DRE) in this patient population. Methods: We conducted a retrospective multicenter cohort study comparing liver transplant recipients with either VRE or DRE bacteremia. The primary outcome was death within 1 year of transplantation. Multivariable logistic regression analyses were performed to calculate adjusted odds ratios for outcomes of interest. Results: We identified 139 cases of Enterococcus bacteremia following LT, of which 78% were VRE and 22% were DRE. When adjusted for total intensive care unit days in the first transplant year, liver-kidney transplantation, and calcineurin inhibitor use, patients with DRE bacteremia were 2.65 times more likely to die within 1 year of transplantation (adjusted odds ratio [aOR], 2.648; 95% CI, 1.025-6.840; P = .044). Prior daptomycin exposure was found to be an independent predictor of DRE bacteremia (aOR, 30.62; 95% CI, 10.087-92.955; P < .001). Conclusions: In this multicenter study of LT recipients with Enterococcus bacteremia, DRE bacteremia was associated with higher 1-year mortality rates when compared with VRE bacteremia. Our data provide strong support for dedicated infection prevention and antimicrobial stewardship efforts for transplant patients. Further research is needed to support the development of better antibiotics for DRE and practical guidance focusing on identification and prevention of colonization and subsequent infection in liver transplant recipients at high risk for DRE bacteremia.