Low Prevalence of Colonization with Vancomycin‐Resistant Enterococcus in Patients Awaiting Liver Transplantation

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Abstract
The orthotopic liver transplant (OLT) population has been particularly affected by the increase in vancomycin‐resistant enterococcus (VRE) infections in recent years. Pre‐transplant colonization prevalence, the role of spontaneous bacterial peritonitis (SBP) antimicrobial prophylaxis as a risk factor, and the risk of post‐OLT infection in colonized patients are all unknowns. We prospectively evaluated OLT candidates at our center with the aim of answering these questions. Vancomycin‐resistant enterococcus colonization status was determined by rectal culture. Data collected included illness severity, antibiotic use (including SBP prophylaxis), waiting time, previous hospitalizations, and invasive procedures. Eighty‐eight patients (31 female, 57 male, median age 52 years) were enrolled. The most common diagnoses were hepatitis C (49%), primary sclerosing cholangitis (13.6%), and alcoholic liver disease. Median MELD score was 11.5 (range 7–24), and median waiting time was 551 days (range 1–2224). Vancomycin‐resistant enterococcus risk factors were common in our patients: recent hospitalization in 16%, recent antibiotic exposure in 39%, and renal insufficiency in 7%. Seventeen percent were receiving SBP prophylaxis. Despite the presence of established risk factors, VRE colonization prevalence was 3.4%. Preliminary limited data showed poor correlation between screening rectal cultures and operative/peri‐operative cultures. Vancomycin‐resistant enterococcus colonization prevalence in an OLT candidate population with mid‐level MELD scores was low, and SBP prophylaxis was not a significant risk factor.