Colonization with methicillin-resistantStaphylococcus aureusafter liver transplantation

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection after orthotopic liver transplantation (OLT). Colonization with MRSA is associated with a higher risk of infection. Previous studies have shown a high prevalence of MRSA colonization among OLT candidates. However, the risk of colonization with MRSA after OLT is still unclear. The objective of this study was to estimate the incidence and the factors associated with colonization with MRSA after OLT. This was a prospective cohort study including patients submitted to OLT between the years 2000 and 2002. Surveillance cultures of nasal swab specimens were performed within the 1st 72 hours of hospital admission and, subsequently, on weeks 2, 6, 13, and 26. Patients whose baseline cultures revealed nasal carriage of MRSA were excluded. A total of 60 patients were included in the study. The median follow-up was 72 days. A total of 9 patients (15%) became colonized. In multiple logistic regression analyses, the use of a urinary catheter for > or =5 days (P = .006), postoperative bleeding at the surgical site (P = .009), and preoperative use of fluoroquinolones (P = .08) were associated with a higher risk of colonization. Patients without any of these risk factors did not become colonized. In conclusion, nasal carriage of MRSA is frequently acquired after OLT. Periodic postoperative screening for MRSA carriage should be an integral component in programs designed to reduce nosocomial MRSA transmission in these patients. Further studies are needed to set up and validate a predictive model that could allow targeting postoperative screening to high-risk OLT recipients.

Outcomes of Colonization with MRSA and VRE Among Liver Transplant Candidates and Recipients

“…The 6.7% probability of detecting MRSA by ASC was lower than that of some recent ICU-based studies, potentially reflecting differences in the frequency of performing ASC and the impact of control measures on decreasing the risk of MRSA acquisition in the study ICU. Santoro-Lopes and colleagues reported an MRSA colonization rate of 15% among liver transplant recipients over a 72-day study period during which five nasal swab specimens were collected (18). This prevalence rate was similar to the cumulative prevalence of MRSA that we detected by ASC (11.1%) performed only on admission over a substantially longer follow-up period.…”

“…Liver transplant candidates and recipients are at increased risk of colonization with multidrug-resistant organisms, including MRSA and VRE, because of critical illness, prolonged hospitalization and broad-spectrum antimicrobial use, organ dysfunction, invasive devices and procedures and immune suppression (3,7,14). However, studies that have examined the clinical impact of MRSA and VRE colonization among liver transplant candidates and recipients may be limited by failure to adjust for severity of illness or other confounders, limited study duration and small sample size (9,(14)(15)(16)(17)(18).…”

Methicillin‐resistant Staphylococcus aureus infection after living‐donor liver transplantation in adults

“…MRSA infection after DDLT has been well described in previous reports (5, 6, 8–11); however, LDLT is different from DDLT in some respects. First, in LDLT, small‐for‐size grafts (13) are often transplanted in adults because the available liver volume from the living donor is limited.…”

“…In some centers, 91% (45 of 49 isolates) of all S. aureus infections after DDLT were caused by MRSA (7). Long‐term use of a urinary catheter, postoperative bleeding at the surgical site, and preoperative use of fluoroquinolones independently increased the risk of MRSA colonization after liver transplantation (11). The clinical outcome of MRSA infection differs from that of MRSA colonization (12) however, and therefore MRSA infection after liver transplantation also should be studied.…”

Skin infections in organ transplant recipients

“…The frequent wound and urinary tract infections of this phase are increasingly being caused by antibiotic‐resistant strains (vancomycin‐resistant enterococci and methicillin‐resistant Staphylococcus aureus , MRSA) [3, 4]. In a recently published study on 60 liver transplant recipients, 15% demonstrated MRSA on nasal swabs for the first time during inpatient treatment [5].…”