Vancomycin resistant enterococcal colonization in solid organ transplant patients: A good prognostic sign for a dismal prognosis

Chris K. Senkowski, Dag Shipshak, Nicholas Namias, Joseph Civetta

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To characterize the incidence and outcome of patients with vancomycin-resistant enteroccocal(VRE) positive cultures in a high volume transplant center. METHODS: A retrospective review of 272 solid organ transplant patients over a one year period at our institution was conducted. All cultures taken in ICU were available for review. RESULTS: Of 272 patients, 20 patients (7.4%) had cultures positive for VRE. Mortality in this group was 70% as compared to 14.6% in non-VRE group(p<0.01 ). Average ICU length of stay was 48 days vs. 4 days in non-VRE(p<0.05) and overall average hospital length of stay was 78 days. The average number of antibiotic courses for these 20 patients was 16.2. A total of 1009 cultures were taken in these patients of which 116 were positive for VRE(5.8 per pt). Sources included blood (8pts), peritoneal fluid (9 pts), line culture (8pts) urine (8 pts) and bronchialveolar lavage (3 pts). Of the 14 deaths, eight patients received autopsy. Of these eight, five(62%) had invasive Klebsiella or Pseudomonas pulmonary infection as cause of death. Two died of multiple organ failure without predominant organism and one had invasive aspergillus. Two patients grew VRE in postmortem blood cultures but no invasive infections were found. Sensitivity patterns of VRE cultures Antibiotic # of cultures tested # sensitive(%) Ampicillin 72 1(1.3%) Clindamycin 55 1(1.8%) Rifampin 25 18(72%) Chloramphenicol 12 12(100%) CONCLUSIONS: VRE positive cultures portend a poor prognosis for survival in the solid organ transplant patient. Colonization with VRE had a high association with common severe ICU gram-negative bacterial infections. Sensitivity to chloramphenicol may provide a new application for an old antibiotic in the management of VRE.

Original languageEnglish
JournalCritical Care Medicine
Volume27
Issue number1 SUPPL.
StatePublished - Dec 1 1999
Externally publishedYes

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Vancomycin
Transplants
Length of Stay
Chloramphenicol
Anti-Bacterial Agents
Gram-Negative Bacterial Infections
Pseudomonas Infections
Klebsiella
Multiple Organ Failure
Clindamycin
Ascitic Fluid
Therapeutic Irrigation
Aspergillus
Ampicillin
Rifampin
Cause of Death
Autopsy
Urine
Lung
Survival

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Vancomycin resistant enterococcal colonization in solid organ transplant patients : A good prognostic sign for a dismal prognosis. / Senkowski, Chris K.; Shipshak, Dag; Namias, Nicholas; Civetta, Joseph.

In: Critical Care Medicine, Vol. 27, No. 1 SUPPL., 01.12.1999.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: To characterize the incidence and outcome of patients with vancomycin-resistant enteroccocal(VRE) positive cultures in a high volume transplant center. METHODS: A retrospective review of 272 solid organ transplant patients over a one year period at our institution was conducted. All cultures taken in ICU were available for review. RESULTS: Of 272 patients, 20 patients (7.4{\%}) had cultures positive for VRE. Mortality in this group was 70{\%} as compared to 14.6{\%} in non-VRE group(p<0.01 ). Average ICU length of stay was 48 days vs. 4 days in non-VRE(p<0.05) and overall average hospital length of stay was 78 days. The average number of antibiotic courses for these 20 patients was 16.2. A total of 1009 cultures were taken in these patients of which 116 were positive for VRE(5.8 per pt). Sources included blood (8pts), peritoneal fluid (9 pts), line culture (8pts) urine (8 pts) and bronchialveolar lavage (3 pts). Of the 14 deaths, eight patients received autopsy. Of these eight, five(62{\%}) had invasive Klebsiella or Pseudomonas pulmonary infection as cause of death. Two died of multiple organ failure without predominant organism and one had invasive aspergillus. Two patients grew VRE in postmortem blood cultures but no invasive infections were found. Sensitivity patterns of VRE cultures Antibiotic # of cultures tested # sensitive({\%}) Ampicillin 72 1(1.3{\%}) Clindamycin 55 1(1.8{\%}) Rifampin 25 18(72{\%}) Chloramphenicol 12 12(100{\%}) CONCLUSIONS: VRE positive cultures portend a poor prognosis for survival in the solid organ transplant patient. Colonization with VRE had a high association with common severe ICU gram-negative bacterial infections. Sensitivity to chloramphenicol may provide a new application for an old antibiotic in the management of VRE.",
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AB - OBJECTIVE: To characterize the incidence and outcome of patients with vancomycin-resistant enteroccocal(VRE) positive cultures in a high volume transplant center. METHODS: A retrospective review of 272 solid organ transplant patients over a one year period at our institution was conducted. All cultures taken in ICU were available for review. RESULTS: Of 272 patients, 20 patients (7.4%) had cultures positive for VRE. Mortality in this group was 70% as compared to 14.6% in non-VRE group(p<0.01 ). Average ICU length of stay was 48 days vs. 4 days in non-VRE(p<0.05) and overall average hospital length of stay was 78 days. The average number of antibiotic courses for these 20 patients was 16.2. A total of 1009 cultures were taken in these patients of which 116 were positive for VRE(5.8 per pt). Sources included blood (8pts), peritoneal fluid (9 pts), line culture (8pts) urine (8 pts) and bronchialveolar lavage (3 pts). Of the 14 deaths, eight patients received autopsy. Of these eight, five(62%) had invasive Klebsiella or Pseudomonas pulmonary infection as cause of death. Two died of multiple organ failure without predominant organism and one had invasive aspergillus. Two patients grew VRE in postmortem blood cultures but no invasive infections were found. Sensitivity patterns of VRE cultures Antibiotic # of cultures tested # sensitive(%) Ampicillin 72 1(1.3%) Clindamycin 55 1(1.8%) Rifampin 25 18(72%) Chloramphenicol 12 12(100%) CONCLUSIONS: VRE positive cultures portend a poor prognosis for survival in the solid organ transplant patient. Colonization with VRE had a high association with common severe ICU gram-negative bacterial infections. Sensitivity to chloramphenicol may provide a new application for an old antibiotic in the management of VRE.

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