Appropriate Vancomycin Use and Incidence of Vancomycin-Resistant Enterococci in Liver Transplant Recipients

Liver transplant recipients (LTRs) are at risk for vancomycin-resistant Enterococcus (VRE) infections which can lead to significant morbidity or mortality. Antibiotic exposure, including vancomycin, is associated with greater risk of VRE infection. This study aimed to assess the appropriateness of vancomycin use and rates of VRE infection in this population. We performed a retrospective cohort study of 327 patients who underwent liver transplantation at our center from January 1, 2012 to June 30, 2017. Sixty (18.3%) LTRs had at least one VRE-positive culture between six-months pre-transplant and six-months post-transplant. LTRs with VRE had greater vancomycin exposure as compared to VRE-negative LTRs (p < 0.05) and were more likely to receive prolonged vancomycin courses (> 72 hours, p < 0.05). Overall appropriateness of vancomycin use > 72 hours among VRE-positive LTRs was only 26.8%. Inappropriate vancomycin use most commonly occurred in patients with presumed sepsis without an identifiable source or pneumonia with negative respiratory cultures. Our findings illustrate an opportunity to improve antibiotic stewardship and reduce vancomycin use in the transplant population