Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation

Yusuke Takemura, Taizo Hibi, Masahiro Shinoda, Hideaki Obara, Takuya Minagawa, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Kentaro Matsubara, Go Oshima, Shutaro Hori, Ken Hoshino, Yohei Yamada, Osamu Itano, Yaoko Takano, Tatsuo Kuroda, Naoki Hasegawa, Yuko Kitagawa

Research output: Contribution to journalArticle

Abstract

Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.

Original languageEnglish
Article numbere13753
JournalClinical Transplantation
DOIs
Publication statusAccepted/In press - 2019 Jan 1

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Living Donors
Methicillin-Resistant Staphylococcus aureus
Liver Transplantation
Infection
Odds Ratio
Mupirocin
Soaps
Cefotaxime
Incidence
Ointments
Hospital Mortality
Glomerular Filtration Rate
Causality
Cohort Studies
Logistic Models

Keywords

  • bloodstream infection
  • living donor liver transplantation
  • MRSA carrier

ASJC Scopus subject areas

  • Transplantation

Cite this

Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation. / Takemura, Yusuke; Hibi, Taizo; Shinoda, Masahiro; Obara, Hideaki; Minagawa, Takuya; Kitago, Minoru; Yagi, Hiroshi; Abe, Yuta; Matsubara, Kentaro; Oshima, Go; Hori, Shutaro; Hoshino, Ken; Yamada, Yohei; Itano, Osamu; Takano, Yaoko; Kuroda, Tatsuo; Hasegawa, Naoki; Kitagawa, Yuko.

In: Clinical Transplantation, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40{\%}) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24{\%} vs. 7{\%}, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.",
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T1 - Methicillin-resistant Staphylococcus aureus carriers are vulnerable to bloodstream infection after living donor liver transplantation

AU - Takemura, Yusuke

AU - Hibi, Taizo

AU - Shinoda, Masahiro

AU - Obara, Hideaki

AU - Minagawa, Takuya

AU - Kitago, Minoru

AU - Yagi, Hiroshi

AU - Abe, Yuta

AU - Matsubara, Kentaro

AU - Oshima, Go

AU - Hori, Shutaro

AU - Hoshino, Ken

AU - Yamada, Yohei

AU - Itano, Osamu

AU - Takano, Yaoko

AU - Kuroda, Tatsuo

AU - Hasegawa, Naoki

AU - Kitagawa, Yuko

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.

AB - Background: Bloodstream infection (BSI) is a life-threatening complication after living donor liver transplantation (LDLT). We aimed to explore the incidence and predisposing factors of BSI at our institution. Methods: We conducted a retrospective cohort analysis on all consecutive adults with BSI within 6 months after LDLT performed between 2005 and 2016. For antimicrobial prophylaxis, ampicillin/sulbactam, cefotaxime, and micafungin were administered. From 2011, methicillin-resistant Staphylococcus aureus (MRSA) carriers were decolonized using mupirocin ointment and chlorhexidine gluconate soap. Risk factors for BSI were identified by uni- and multivariate logistic regression. Results: Of a total of 106 LDLTs, 42 recipients (40%) suffered BSI. The BSI group demonstrated significantly higher in-hospital mortality rates compared with the non-BSI group (24% vs. 7%, P =.01). We identified MRSA carrier (odds ratio [OR], 19.1; P <.001), ABO incompatibility (OR, 2.9; P =.03), and estimated glomerular filtration rate <30 mL/min/1.73m2 (OR, 15.8; P =.02) as independent risk factors for BSI. Decolonization treatment for MRSA carriers did not reduce the incidence of all-cause BSI but reduced the frequency of BSI caused by MRSA. Conclusion: To our knowledge, for the first time, MRSA carriers were revealed to be highly vulnerable to BSI after LDLT.

KW - bloodstream infection

KW - living donor liver transplantation

KW - MRSA carrier

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