Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026
Impact of Vancomycin-Resistant Enterococci (VRE)-Active Perioperative Prophylaxis in Liver Transplant Patients Colonized by VRE.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Burastero Giulia Jole, Wey Emmanuel Q, Guidetti Veronica, Cantergiani Samuele, Menozzi Valentina, Lo Porto Davide, Cona Andrea, Khan Amreen, Serra Valentina, Assirati Giacomo, Guaraldi Giovanni, Dolci Giovanni, Meschiari Marianna, Cervo Adriana, Tosi Martina, Gruttadauria Salvatore, Pollok Joerg-Matthias, Di Benedetto Fabrizio, Mularoni Alessandra, Mussini Cristina, Franceschini Erica
Аннотация
BACKGROUND: Data regarding the effectiveness of vancomycin-resistant Enterococci (VRE)-active prophylaxis for preventing early post-liver transplantation (LT) VRE infections in VRE-colonized patients are scarce.
METHODS: 131 pre-LT VRE-colonized patients who underwent LT were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.
RESULTS: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69; 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active versus non-VRE-active groups at 7 (0 [0.0%] vs 2 [3.2%]; P = .222), 14 (4 [5.7%] vs 4 [6.4%]; P = 1.000), and 30 (6 [8.7%] vs 8 [12.9%]; P = .621) days post-LT, respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank P = .16 with Kaplan-Meier analysis; odds ratio [OR]: .643; 95% CI: .210-1.969; P = .439 with univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared with the control group (11 [15.9%] vs 20 [32.2%]; P = .047). Tigecycline prophylaxis was associated with a lower risk of early-onset infections with multivariate analysis (OR: .106; 95% CI: .015-.745; P = .024) and after adjusting for propensity score (adjusted OR: .146; 95% CI: .031-.708; P = .017).
CONCLUSIONS: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.
METHODS: 131 pre-LT VRE-colonized patients who underwent LT were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.
RESULTS: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69; 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active versus non-VRE-active groups at 7 (0 [0.0%] vs 2 [3.2%]; P = .222), 14 (4 [5.7%] vs 4 [6.4%]; P = 1.000), and 30 (6 [8.7%] vs 8 [12.9%]; P = .621) days post-LT, respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank P = .16 with Kaplan-Meier analysis; odds ratio [OR]: .643; 95% CI: .210-1.969; P = .439 with univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared with the control group (11 [15.9%] vs 20 [32.2%]; P = .047). Tigecycline prophylaxis was associated with a lower risk of early-onset infections with multivariate analysis (OR: .106; 95% CI: .015-.745; P = .024) and after adjusting for propensity score (adjusted OR: .146; 95% CI: .031-.708; P = .017).
CONCLUSIONS: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.