Vancomycin-resistant Enterococci: Differing Rates and Patterns of Colonization in Liver vs. Non-Liver Solid Organ Transplant. (4th October 2017) - McFarlane, Alexandra
Abstract: Background: Vancomycin-resistant enterococci (VRE) colonization in liver transplant recipients is associated with negative outcomes such as VRE infection, longer hospitalizations, and death. Less is known about VRE colonization in non-liver solid organ transplant (SOT) recipients. The purpose of this study was to describe the epidemiology of VRE colonization in non-liver SOT patients in one major Canadian organ transplant center and compare it to the liver transplant population. Methods: Single-center retrospective review of SOT between 2005 and 2015. Cross-referencing of our provincial infection control and SOT databases identified SOT patients who were colonized with VRE during their peri-transplant period. This period was defined as 3 months before to 1 year after transplant. All surveillance cultures, whether positive or negative, and all clinical cultures positive for VRE, were obtained. Patients were considered VRE colonized pre-transplant if they had a positive culture before, or within 48 hours of their transplant. Results: During the study period, there were 663 liver and 1617 non-liver transplants, of which 130 (20%) and 149 (9%) were VRE colonized, respectively ( P < 0.001). The rate of VRE colonization in the non-liver group differed by specific organ including: lung/heart–lung 84/437 (19%), heart 17/240 (7%), kidney 36/854 (4%), and miscellaneous 11/86 (13%). The pattern of colonization was different between organs, as depicted in the figure ( P < 0.001). Forty-nine percent of liver patients were already colonized before transplant, compared with 17% in non-liver. In all organs, there was a high incidence of new VRE colonization in the immediate post-transplant period. Conclusion: The rate and pattern of VRE colonization differ by transplant organ. Overall rates approach those in the liver cohort for lung/heart–lung, despite no manipulation of the biliary tract, or breach of the peritoneum. Future study should determine risk factors for VRE colonization in non-liver SOT and assess if colonization is associated with worse outcomes in non-liver patients. Disclosures: All authors: No reported disclosures.