Impact of VRE-active perioperative prophylaxis in liver transplant patients colonized by Vancomycin-Resistant Enterococci

Background: Data regarding the effectiveness of vancomycin resistant Enterococci (VRE) active prophylaxis for preventing early post-liver transplant (LT) VRE infections in VRE-colonized patients are scarce. Methods: One-hundred-thirty-one pre-LT VRE colonized patients who underwent liver transplantation were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not. Results: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69, 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active vs non-VRE-active groups at 7 [0 (0.0 %) vs 2 (3.2 %), p=0.222], 14 [4 (5.7 %) vs 4 (6.4%), p=1.000] and 30 [6 (8.7%) vs. 8 (12.9%), p=0.621] days post-LT respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank p=0.16 at Kaplan-Meier analysis; OR 0.643, 95% CI 0.210-1.969, p=0.439 at univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared to the control group [11 (15.9%) vs. 20 (32.2%), p=0.047]. Tigecycline prophylaxis was associated with a lower risk of early-onset infections at multivariate analysis (OR 0.106, 95% CI 0.015-0.745, p=0.024) and after adjusting for propensity score (aOR 0.146, 95% CI 0.031-0.708, p=0.017). Conclusions: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.