Russell DL et al. (2008) Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 8: 1737–1743

Liver transplant candidates and recipients are susceptible to colonization by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Infection of liver transplant recipients by MRSA and VRE increases the risk of morbidity and mortality. To assess the clinical impact of colonization by MRSA and VRE, Russell et al. obtained active surveillance cultures from 706 liver transplant candidates and recipients within 24 h of admission to a liver transplant intensive care unit. Patients were followed until the study end point, they died or were lost to follow-up.

MRSA colonization was found to be associated with an increased risk of infection (adjusted odds ratio [OR] 15.64; 95% CI 6.63–36.89), and the risk of death was approximately twofold higher in patients who developed an MRSA infection. Although MRSA colonization was not itself significantly associated with an increased risk of death, it was associated with an earlier time to death. By contrast, VRE colonization was associated with an increased risk of infection (adjusted OR 3.61%; 95% CI 2.01–6.47) and death (adjusted OR 2.12; 95% CI 1.27–3.54). Colonization by either MRSA or VRE was also associated with a shorter time to infection.

In light of these findings, the authors advocate the use of active surveillance cultures and any necessary contact precautions during hospitalization of liver transplant candidates and recipients, particularly in an intensive care setting.