Prevalence of MRSA Bacteremia in Liver Transplant Patients: A Systematic Review and Meta-Analysis

Document Type : Analytic Review

Authors
A. Emami 1
F. Javanamardi 2
A. Rezaei 3
N. Pirbonyeh 1
1 Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
2 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Shiraz University of Medical Sciences
10.52547/iem.8.3.277
Abstract
Backgrounds: Infection is one of the major threats to liver transplant patients and significantly affects associated mortality and morbidity. Serious infections are likely to occur a few months after transplantation, and most of them are bacterial. The aim of this study was to evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in liver transplant patients.

Materials & Methods: In this systematic review and meta-analysis, Preferred Reporting Items for systematic reviews and meta-analysis guidelines were used. International databases including PubMed, Scopus, Web of Sciences, Embase, and Cochrane were searched by related MeSH terms and keywords for studies published until July 26, 2020. The current study was registered by a pre-defined protocol in PROSPRO.

Findings: After a comprehensive literature search, 11 articles were selected for inclusion in the analysis. The prevalence of MRSA in liver transplant patients was 75% (95% CI: 58% - 89%); however, an evident heterogeneity was observed between the studies (I2= 87.84%, p< .001).

Conclusion: In conclusion, this study results demonstrate that the prevalence of post-transplant MRSA colonization bacteremia is high among liver transplant patients. This should be considered seriously, and efforts should be made to prevent mortality in this group of patients.

Keywords

Subjects

1. Bert, F., et al., Risk factors for Staphylococcus aureus infection in liver transplant recipients. Liver transplantation, 2005. 11(9): p. 1093-1099.
2. Souza, M.V.d., et al., Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000). Arquivos de gastroenterologia, 2007. 44(2): p. 128-132.
3. Florescu, D., et al., Staphylococcus aureus infections after liver transplantation. Infection, 2012. 40(3): p. 263-269.
4. Emami, A., et al., Noncoding control region pattern of BK polyomavirus in kidney transplant patients with nephropathy. Experimental and clinical transplantation: official journal of the Middle East Societ Organ Transplant, 2015.
5. Kalil, A.C., H. Dakroub, and A.G. Freifeld, Sepsis and solid organ transplantation. Current drug targets, 2007. 8(4): p. 533-541.
6. Kim, S., et al. Strategies to reduce infectious complication using epidemiologic data analysis in liver transplant recipients. in Transplantation Proceedings. 2013. Elsevier.
7. Al-Mukhtar, A., et al., A simple prophylaxis regimen for MRSA: its impact on the incidence of infection in patients undergoing liver resection. The Annals of The Royal College of Surgeons of England, 2009. 91(1): p. 35-38.
8. Takatsuki, M., et al., The outcomes of methicillin-resistant Staphylococcus aureus infection after living donor liver transplantation in a Japanese center. Journal of hepato-biliary-pancreatic sciences, 2010. 17(6): p. 839-843.
9. de Souza, M.V., et al., Infections after liver transplantation in adults: data from a university hospital in southern Brazil (1996-2000). Arquivos de gastroenterologia, 2007. 44(2): p. 128-132.
10. Lo, C.K.-L., D. Mertz, and M. Loeb, Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC medical research methodology, 2014. 14(1): p. 45.
11. Bedini, A., et al. Gram-positive bloodstream infections in liver transplant recipients: incidence, risk factors, and impact on survival. in Transplantation proceedings. 2007. Elsevier.
12. Bert, F., et al., Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: an analysis of 259 episodes. Liver Transplantation, 2010. 16(3): p. 393-401.
13. Bodro, M., et al., Extensively drug-resistant Pseudomonas aeruginosa bacteremia in solid organ transplant recipients. Transplantation, 2015. 99(3): p. 616-622.
14. Hassan, E.A., et al., Health care-associated infections in pre-transplant liver intensive care unit: Perspectives and challenges. Journal of infection and public health, 2018. 11(3): p. 398-404.
15. Iida, T., et al., Posttransplant bacteremia in adult living donor liver transplant recipients. Liver Transplantation, 2010. 16(12): p. 1379-1385.
16. Kim, H.K., et al., Epidemiology and clinical features of post-transplant bloodstream infection: an analysis of 222 consecutive liver transplant recipients. Infection & chemotherapy, 2013. 45(3): p. 315-324.
17. Nafady‐Hego, H., et al., Pattern of bacterial and fungal infections in the first 3 months after pediatric living donor liver transplantation: An 11‐year single‐center experience. Liver Transplantation, 2011. 17(8): p. 976-984.
18. Singh, N., et al., Methicillin-resistant Staphylococcus aureus: the other emerging resistant gram-positive coccus among liver transplant recipients. Clinical infectious diseases, 2000. 30(2): p. 322-327.
19. Shi, S.-h., et al., Coagulase-negative staphylococcus and enterococcus as predominant pathogens in liver transplant recipients with Gram-positive coccal bacteremia. Chinese medical journal, 2010. 123(15): p. 1983-1988.
20. Lee, S.O., et al., Spectrum of early-onset and late-onset bacteremias after liver transplantation: implications for management. Liver Transpl, 2011. 17(6): p. 733-41.
21. Zhou, J., et al., Staphylococcus aureus bacteremias following liver transplantation: a clinical analysis of 20 cases. Therapeutics and Clinical Risk Management, 2015. 11: p. 933.
22. Lodise, T.P., P.S. McKinnon, and M. Rybak, Prediction model to identify patients with Staphylococcus aureus bacteremia at risk for methicillin resistance. Infection Control & Hospital Epidemiology, 2003. 24(9): p. 655-661.
23. Jafarpour, Z., et al., Bacterial infections in the early period after liver transplantation in adults: A prospective single-center cohort study. Microbiology and Immunology, 2020. 64(6): p. 407-415.
24. Wan, Q., et al. The risk factors for mortality in deceased donor liver transplant recipients with bloodstream infections. in Transplantation Proceedings. 2013. Elsevier.
25. Karvellas, C.J., et al., Bloodstream infection after elective liver transplantation is associated with increased mortality in patients with cirrhosis. Journal of Critical Care, 2011. 26(5): p. 468-474.
26. Bleasdale, S.C., et al., Effectiveness of chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Archives of internal medicine, 2007. 167(19): p. 2073-2079.
27. Singh, N., et al., Impact of an aggressive infection control strategy on endemic Staphylococcus aureus infection in liver transplant recipients. Infection Control & Hospital Epidemiology, 2006. 27(2): p. 122-126.
28. Ziakas, P.D., T. Anagnostou, and E. Mylonakis, The prevalence and significance of methicillin-resistant Staphylococcus aureus colonization at admission in the general ICU setting: a meta-analysis of published studies. Critical care medicine, 2014. 42(2): p. 433-444.
29. Paterson, D.L., et al., Lack of efficacy of mupirocin in the prevention of infections with staphylococcus aureus in liver transplant recipients and candidates1. Transplantation, 2003. 75(2): p. 194-198.
30. Chen, S.L., et al., [Efficacy and safety of linezolid among patients with methicillin-resistant Staphylococcus aureus bacteremia]. Zhonghua Yi Xue Za Zhi, 2017. 97(14): p. 1084-1088.
31. Saner, F.H., et al., Successful salvage therapy with tigecycline after linezolid failure in a liver transplant recipient with MRSA pneumonia. Liver Transpl, 2006. 12(11): p. 1689-92.
32. Liu, C., et al., Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis, 2011. 52(3): p. e18-55.
33. Joson, J., et al., Successful treatment of methicillin-resistant Staphylococcus aureus mitral valve endocarditis with sequential linezolid and telavancin monotherapy following daptomycin failure. Journal of antimicrobial chemotherapy, 2011. 66(9): p. 2186-2188.
Infection Epidemiology and Microbiology
Volume 8, Issue 3
September 2022
Pages 277-284