33. Appropriate vancomycin use and incidence of vancomycin-resistant enterococci (VRE) infection in liver transplant recipients
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
  • ID Week Poster 9.25.pdf (279.6 kB)
  • Background: Liver transplant recipients (LTRs) have high rates of antibiotic exposure and are at increased risk for infections by organisms with multi-drug resistance, including VRE. This study aims to assess appropriateness of vancomycin use and incidence of VRE infection in this population.

    Methods: This is a retrospective cohort study of 330 LTRs transplanted at a single tertiary center between January 2012 and June 2017. Chart review was performed to identify LTRs who received vancomycin and/or had history of VRE infection (defined by positive VRE cultures from blood, urine or intra-abdominal fluid). Vancomycin use >72 hours after initiation was judged appropriate if used for treatment of MRSA or bacterial infections for which vancomyocin is the drug of choice, skin or deep seated infections where cultures may not be available.

    Results: Among 330 LTRs, 69% received 1 or more doses of vancomycin. 68 patient (20.5%) had 1 or more positive culture for VRE; of these, 38% (n = 26) had bacteremia, 46% (n = 31) had positive urine cultures and 13% (n = 9) had positive abdominal fluid cultures. Of the 97 episodes with VRE-positive cultures, 78% were treated (n = 76), most commonly with linezolid or daptomycin. Patients with VRE-positive cultures had greater total days of vancomycin exposure (p < 0.0001) than those without, although the rate of vancomycin exposure of >72 hours of these 2 groups did not reach statistical difference (p = 0.044). The most common reasons for vancomycin use >72 hours are shown (Table 1). Overall appropriateness of vancomycin use over 72 hours was only 26%.

    Conclusion: Our study demonstrates an opportunity for antimicrobial stewardship in this challenging population. We found that the total number of days of vancomycin was significantly higher in patients with positive VRE cultures, which highlights even short courses of vancomycin may promote VRE infection/colonization. Our findings show three quarters of vancomycin use over 72 hours was inappropriate.

    Table 1: Appropriateness of prolonged (>72 hrs) vancomycin use

    Suspected infectious source (per documentation)

    Number of Events

    % Appropriate vancomyocin use

    Bacteremia, Sepsis/SIRS NOS






    Respiratory tract






    Skin/Soft Tissue









    Jessica Ferguson, MD, Internal Medicine, Stanford Health Care, Stanford, CA, Marisa Holubar, MD, MS, Antimicrobial Safety & Sustainability Program, Stanford Health Care, Stanford, CA, Waldo Concepcion, MD, Surgery, Stanford University School of Medicine, Stanford, CA and Dora Ho, MD, PhD, Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA


    J. Ferguson, None

    M. Holubar, None

    W. Concepcion, None

    D. Ho, None

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