Clinical impact of Vancomycin Resistant Enterococci colonization in non-liver solid organ transplantation and its implications for infection control strategies: A single centre 10 year retrospective study.

Abstract

BACKGROUND\nVancomycin Resistant Enterococci (VRE) colonization in non-liver solid organ transplantation (SOT) is poorly defined. Infection control management of these patients is influenced by the association of VRE with adverse outcomes in liver transplantation. This study examines the frequency and clinical impact of VRE colonization specifically on non-liver SOT patients and discusses implications for nosocomial VRE control.\n\n\nMETHODS\nWe retrospectively reviewed all non-liver SOT patients at a single transplant centre from 2005-2015. We determined colonization rates in the peri-transplant period and the rate of VRE infections. The association between VRE colonization with 90-day mortality and other clinical outcomes was examined.\n\n\nRESULTS\nThere were 1786 non-liver solid organ transplants from 2005-2015, with 81 (4.6%) colonized with VRE in the peri-transplantation period. The colonization prevalence varied by organ type: 45/423 lung (10.6%), 12/352 heart (3.4%), 1/18 heart-lung (5.6%), 20/884 kidney (2.3%), 3/63 kidney-pancreas (4.8%), 0/11 pancreas, 0/5 small bowel, and 0/11 multi-visceral. Peri-transplant VRE colonization was not associated with 90-day mortality OR = 2.35 (95%CI = 0.53,10.29) and aOR = 1.52 (95%CI = 0.34,6.88). In the multivariable logistic regression there was no association with mortality at 1-year or 5-years, hospital length of stay, rehospitalization or days alive out of hospital. There were 14 inpatient VRE infections up to one year post transplantation.\n\n\nCONCLUSION\nNon-liver SOT patients have lower rates of VRE colonization than liver SOT, and colonization was not associated with increased adverse clinical outcomes. While infection control strategies for VRE in hospital remain controversial, non-liver SOT should be considered among typical hospitalized patients when designing strategies for prevention. This article is protected by copyright. All rights reserved.