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Korean J Crit Care Med > Volume 21(2); 2006 > Article
Korean Journal of Critical Care Medicine 2006;21(2): 95-100.
간이식 후 Vancomycin-resistant Enterococcus와 Methicillin-resistant Staphylococcus aureus 집락에 대한 후향적 연구
정지연·김성환·배성심·정철우·이국현
서울대학교병원 마취통증의학과
Vancomycin-resistant Enterococcus and Methicillin-resistant Staphylococcus aureus Colonization in Liver Transplant Recipients : A Matched Control Study
Ji Yeon Jeong, Sunghwan Kim, Sung Sim Bae, Chul Woo Jung, Kook Hyun Lee
Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. leekh@plaza.snu.ac.kr
ABSTRACT
BACKGROUND: Despite improvements in surgical technique and immunosuppression, infection following liver transplantation (LT) remains a significant problem. Vancomycin-resistant Enterococcuscus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have become important nosocomial pathogens. This study was undertaken in attempt to evaluate clinical impact of VRE and MRSA in LT recipients. METHODS: LT recipients with VRE or MRSA colonization from 2001 to 2004 were identified and matched (age, gender, United Network for Organ Sharing status, liver disease, and transplant date) to control groups without MRSA or VRE colonization. Demographics, clinical factors, length of stay, duration of the use of the mechanical ventilator, complications and survival rates were compared with matched controls. RESULTS: Eleven patients were colonized by VRE (4.7%) and thirty patients by MRSA (13%). The common sites of VRE culture included the tip of the urinary catheter and urine. The VRE colonized group experienced more biliary complications, relaparotomies, longer length of stay at ICU and ward, and longer use of the mechanical ventilator. One year survival rate was lower in the VRE group. MRSA was commonly cultured from sputum, tip of the central venous catheter or intraarterial catheter, and blood. The MRSA group experienced more relaparotomies, pneumonia, longer stay at ICU and ward, and longer use of mechanical ventilator compared to the control. One year survival rate was lower in the MRSA group. Rejection was not associated with VRE or MRSA infection. CONCLUSIONS: VRE or MRSA colonization is associated with higher incidence of posttransplant complications and lower survival rate than LT recipients without VRE or MRSA colonization. The patients with VRE or MRSA colonization also utilized more hospital resources.
Key Words: Liver transplantation; Methicillin-resistant Staphylococcus aureus; Vancomycin-resistant Enterococcus
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