1086. Outcomes of Daptomycin Peri-Operative Prophylaxis in Liver Transplant Recipients Colonized with Vancomycin-Resistant Enterococcus  
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA_dapto handout.pdf (231.3 kB)
  • Background: 

    Vancomycin-resistant enterococcus (VRE) is a significant nosocomial pathogen in solid-organ transplantation. VRE colonization in liver transplantation has been associated with a 3-fold risk of VRE infection and 2-fold increased risk of mortality.  The objective of this study is to assess whether antimicrobial prophylaxis against VRE mitigates these risks. The study hypothesis is peri-operative prophylaxis with daptomycin will decrease the risk of infection and mortality in VRE-colonized liver transplant recipients.

    Methods: 

    A retrospective chart review of adult liver transplant recipients from July 2008 to April 2011 was performed. VRE positivity was defined as VRE isolated from a clinical microbiology specimen or active surveillance via a peri-rectal swab. VRE negative was defined as a negative result on peri-rectal swab or no history of VRE isolated from any clinical specimen. The VRE positive cohort received daptomycin (6mg/kg) prior to incision and continued for 48 hours post-transplant in addition to standard anti-infective prophylaxis. The VRE negative cohort received only standard anti-infective prophylaxis. The primary outcomes were rate of VRE infection, overall infection rate, and 28 day mortality rate. Secondary outcomes were 6 month evaluation of primary outcomes and 6 month mortality rate.

    Results: 

    There were 31 patients in the VRE positive cohort and 59 in the VRE negative cohort. For each cohort respectively, VRE infection rate was 2 v. 0 infections per 100 patient days (0.23% v. 0%), p = 0.21), overall infection rate was 7 v. 4 infections per 100 patient days (0.8% v. 0.29%, p = 0.10).  At 6 months, there was no graft loss in the VRE positive group, 3 graft losses in the VRE negative group (p= 0.55). The 6 month VRE infection rate was 2 v. 0 (0.04% v 0%, p =0.19).  For mortality at 28 days and at 6 months, there was 1 death in the VRE negative cohort, none in the VRE positive cohort.

    Conclusion: 

    The infection and mortality rates in the VRE positive liver transplant recipient cohort after daptomycin prophylaxis were comparable to the VRE negative cohort. Prophylaxis with daptomycin in VRE colonized liver transplant patients may decrease morbidity and mortality providing similar outcomes compared to VRE negative patients.


    Subject Category: O. Transplant infectious diseases

    Christy Varughese, PharmD1, Michael Schilsky, MD1,2, Eric Tichy, PharmD1, Sukru Emre, MD1,2 and Jeffrey Topal, MD1,2, (1)Yale-New Haven Hospital, New Haven, CT, (2)Yale School of Medicine, New Haven, CT

    Disclosures:

    C. Varughese, None

    M. Schilsky, None

    E. Tichy, None

    S. Emre, None

    J. Topal, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.