An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

E. A. Dominguez, J. C. Davis, Alan Norman Langnas, B. Winfield, S. J. Cavalieri, Mark Edmund Rupp

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5- month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour- clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.

Original languageEnglish (US)
Pages (from-to)586-590
Number of pages5
JournalLiver Transplantation and Surgery
Volume3
Issue number6
DOIs
StatePublished - Jan 1 1997

Fingerprint

Enterococcus faecium
Disease Outbreaks
Liver
Biliary Tract
Clone Cells
Infection
Anti-Bacterial Agents
Mortality
Environmental Monitoring
Cephalosporins
Vancomycin
Infection Control
Bacteremia
Microbiology
Radiology
Liver Transplantation
Electrophoresis
Vancomycin-Resistant Enterococci
Transplant Recipients
Case-Control Studies

ASJC Scopus subject areas

  • Surgery
  • Hepatology

Cite this

An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients. / Dominguez, E. A.; Davis, J. C.; Langnas, Alan Norman; Winfield, B.; Cavalieri, S. J.; Rupp, Mark Edmund.

In: Liver Transplantation and Surgery, Vol. 3, No. 6, 01.01.1997, p. 586-590.

Research output: Contribution to journalArticle

Dominguez, E. A. ; Davis, J. C. ; Langnas, Alan Norman ; Winfield, B. ; Cavalieri, S. J. ; Rupp, Mark Edmund. / An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients. In: Liver Transplantation and Surgery. 1997 ; Vol. 3, No. 6. pp. 586-590.
@article{e98de4d813f04635b690cf0ff37c1e39,
title = "An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients",
abstract = "Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5- month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50{\%} (3 adults and 1 child). Mortality in bacteremic patients was 57{\%}. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour- clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.",
author = "Dominguez, {E. A.} and Davis, {J. C.} and Langnas, {Alan Norman} and B. Winfield and Cavalieri, {S. J.} and Rupp, {Mark Edmund}",
year = "1997",
month = "1",
day = "1",
doi = "10.1002/lt.500030605",
language = "English (US)",
volume = "3",
pages = "586--590",
journal = "Liver Transplantation",
issn = "1527-6465",
publisher = "John Wiley and Sons Ltd",
number = "6",

}

TY - JOUR

T1 - An outbreak of vancomycin-resistant Enterococcus faecium in liver transplant recipients

AU - Dominguez, E. A.

AU - Davis, J. C.

AU - Langnas, Alan Norman

AU - Winfield, B.

AU - Cavalieri, S. J.

AU - Rupp, Mark Edmund

PY - 1997/1/1

Y1 - 1997/1/1

N2 - Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5- month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour- clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.

AB - Vancomycin-resistant Enterococcus faecium (VREF) has become a significant nosocomial pathogen for immunosuppressed patients. During a 5- month period in 1993, 8 cases of invasive infection with VREF (7 with bacteremia) were identified in liver transplant recipients, half of whom were adults. Epidemiology and microbiology studies were designed to identify the source and to determine the risk factors for this infection. Overall mortality was 50% (3 adults and 1 child). Mortality in bacteremic patients was 57%. A case-control study showed that cases were more likely to have been treated with a third-generation cephalosporin or vancomycin and to have undergone more than four biliary tract procedures. Environmental surveillance cultures yielded only one VREF isolate from a rectal temperature probe, but this device was used in only 2 of the cases. Cultures from all surgery and radiology suites were negative. All VREF isolates were genotyped by contour- clamped homogenous electric field electrophoresis of chromosomal DNA restriction fragments. These studies showed that a single clone was responsible for the outbreak, although other clones could be detected in the hospital. After implementing strict contact isolation on the liver transplant unit, only 1 additional patient with VREF was identified during this outbreak. In conclusion, it was found that antibiotic use and biliary tract manipulation were risk factors for developing invasive infections with VREF after liver transplantation. Optimal treatment is still unclear but most likely includes a combination of two or more antibiotics. Prompt institution of infection control measures can preclude rapid spread of this nosocomial pathogen.

UR - http://www.scopus.com/inward/record.url?scp=0030684041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030684041&partnerID=8YFLogxK

U2 - 10.1002/lt.500030605

DO - 10.1002/lt.500030605

M3 - Article

C2 - 9404957

AN - SCOPUS:0030684041

VL - 3

SP - 586

EP - 590

JO - Liver Transplantation

JF - Liver Transplantation

SN - 1527-6465

IS - 6

ER -