Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of sepsis in patients with cirrhosis and after liver transplantation. The association between nasal carriage of MRSA and sepsis in these patients is unclear. The goal of this study was to investigate the relationship between MRSA carriage before liver transplantation and subsequent sepsis after transplantation. This was a retrospective study of 374 consecutive adults who underwent orthotopic liver transplantation between 1998 and 2001 and for whom full data were available. Of these, 157 had been screened for MRSA as part of a study assessing the prevalence of MRSA infection. All MRSA carriers were treated with nasal mupirocin and chlorhexidine baths. The records of MRSA carriers and noncarriers were analyzed for Child and Model for End-Stage Liver Disease (MELD) score, posttransplantation MRSA, and other infections and mortality. Of the 157 patients who had an MRSA screen, 35 patients were MRSA nasal carriers. These carriers had significantly greater MELD score (mean, 16.2 compared with 13.1; P ‫؍‬ .02) and Child scores (mean, 10 versus 9; P ‫؍‬ .001) than noncarriers. The incidence of posttransplantation MRSA infection was significantly higher in MRSA carriers (31% versus 9%; P ‫؍‬ .002). The incidence of other posttransplantation infection was not significantly different in the two groups. There was no significant difference in survival between the two groups (1-year patient survival, 74% and 82%, respectively). Patients carrying MRSA are predisposed to an increased risk of sepsis after liver transplantation with a trend to increased mortality. Screening for MRSA should be considered in high-risk patients being assessed for liver transplantation. (Liver Transpl 2003;9: 754-759.)

MRSA and VRE Colonization in Solid Organ Transplantation: A Meta-Analysis of Published Studies

“…These data were exclusively for patients who had undergone liver transplantation. We found that pretransplant MRSA carriage in liver transplant recipients (15,19,23 (16,17,27,36) with pertinent data. The Freitas et al (16) study had zero events in both arms and was not pooled.…”

“…The pooled effects and sensitivity analyses are displayed in Table 2. Before transplantation, the estimated MRSA colonization was 8.5% (95% CI 3.2-15.8; effect derived from nine studies (13)(14)(15)19,(21)(22)(23)29,33) in 2885 patients (t 2 ¼ 0.107) and VRE colonization was 11.9% (95% CI 6.8-18.2; effect derived from eight studies (14,17,18,20,24,25,35,36) that included 1381 patients (t 2 ¼ 0.060). Effects referred to liver patients exclusively for VRE, whereas for MRSA two out of nine eligible studies reported data on kidney and/or pancreas and lung patients (13,33).…”

“…Singh et al (18) demonstrated a significant decline in MRSA infections in transplant patients when a bundle of surveillance, isolation with cohorting and decolonization of MRSA carriers with mupirocin was implemented; however, there are no randomized studies to address the issues of preventive strategies among transplant recipients. Among the studies included in our meta-analysis only a few have used decolonization protocols preoperatively or postoperatively (13,15,21,23,29), and 4 out of 23 used contact precautions for MRSA or VRE colonized patients (14,15,19,21) (Table 1). Given the impermanence of the decolonization effect, timing for patients awaiting deceased donor transplantation is difficult to be determined.…”

“…Of note, four out of six studies (13,15,21,23) included in this analysis had MRSA decolonization interventions in their protocol. MRSA presents a growing challenge for healthcare practitioners worldwide (43 VRE is not considered highly pathogenic; however, a higher risk is associated with patients in dialysis units, neonatal units, hematology/oncology wards and liver transplantation units (44).…”

Síntese e determinação da atividade antimicrobiana de derivados 5-nitro-2-tiofilidênicos frente a Staphylococcus aureus multi-resistente

“…Infecções causadas por cepas resistentes de Staphylococcus aureus não se caracterizam como fenômeno isolado ou exclusivo de países de baixa renda, uma vez que se observa número crescente de estudos relacionados à epidemiologia deste microorganismo em centros que comportam pacientes imunocomprometidos (Lizioli et al, 2003), que sofreram intervenção cirúrgica , que foram transplantados (Desai et al, 2003) ou que são portadores de queimaduras graves (Fuchs et al, 2002). Notase ainda, uma grande preocupação da comunidade científica em estabelecer possíveis alternativas relacionadas ao controle e prevenção da colonização por MRSA (Methicillin-Resistant Staphylococcus aureus) em hospitais de todo o mundo, ressaltando a gravidade e a necessidade de busca de soluções para este problema Rohr et al, 2003).…”