Abstract
Background: The prevalence of vancomycin-resistant enterococci (VRE) is increasing among liver transplant recipients. This study aimed to explore the clinical features of liver transplant recipients with VRE infection/colonization and to determine the impact of daptomycin dosage on the outcomes. Methods: We retrospectively enrolled pre-transplant and post-transplant patients with VRE colonization/infection from 2016 to 2019. Results: Altogether, 428 patients underwent liver transplantation. Among these, 22 (5.1%) patients developed VRE colonization/infection. All VRE isolates were Enterococcus faecium. Two (9%) patients acquired VRE in the pre-transplant period, 16 (3 colonizations and 13 infections) (72.7%) in the early post-liver transplant period (≤60-day after transplantation), and 4 (2 colonization and 2 infections) (18.1%) in the late post-liver transplant period (>6-month after transplantation). Among 13 patients with early post-liver transplant VRE infection, 12 (92.3%) underwent living-donor liver transplantation and 1 underwent deceased donor liver transplantation. Among these 13 patients, the median time from transplant to emergence of VRE infection was 12 days. The median interval from VRE infection to death was 27 days and the 30-day mortality was 67%. Of these 13 patients, eleven patients (8 survived; 3 died) received daptomycin therapy for VRE. Among them, 4 (36.3%) received daptomycin doses <8 mg/kg. Non-survivors (n=3) received significantly lower daptomycin dose than survivors (n=8) (P=0.040). Daptomycin doses <8mg/kg were more frequently associated with non-survivors (n=3) than with survivors (n=8) (P=0.024). Conclusions: In summary, the suboptimal dosage of daptomycin may have contributed to a higher rate of in-hospital mortality. Doses ≥8 mg/kg may be needed to adequately treat VRE infection in early post-liver transplant recipients.Level of evidence: Level III
Importance of daptomycin dosage on the clinical outcomes in early post-liver transplant recipients with vancomycin-resistant enterococci infection
