The dominant sequence types of vancomycin-resistant Enterococcus faecium among transplantation ward patients

Evaluation of the prevalence of insertion element IS16 in vancomycin-resistant enterococci strains of Enterococcus faecium isolated from transplantology patients from a Warsaw Hospital between 2010 and 2012

The study included 79 vancomycin-resistant Enterococcus faecium (VRE) strains isolated from 33 patients after kidney (n = 19) or liver (n = 14) transplantation; these patients were hospitalized between 2010 and 2012. The strains were obtained from infected persons as well as from carriers. All examined strains were tested for the susceptibility to antimicrobials active against enterococci and for the presence of vanA and vanB genes as well as the presence of the insertion sequence IS16 considered as one of the markers of hospital-associated strains. All 79 VRE strains of E faecium possessed IS16 and the vanA (vanB-negative) determinant. All tested strains were resistant to at least three groups of drugs; therefore, they were recognized as multidrug resistant. All isolates were resistant to glycopeptides, ampicillin, and most were resistant to tetracyclines, macrolides, nitrofurans, and high concentrations of aminoglycosides. The presence of insertion element IS16 and multiple resistance determinants prove that strains colonizing or infecting solid organ recipients were typical nosocomial pathogens.

Multidrug-resistant bacterial infections after liver transplantation: An ever-growing challenge

Bacterial infections are a leading cause of morbidity and mortality among solid organ transplant recipients. Over the last two decades, various multidrug-resistant (MDR) pathogens have emerged as relevant causes of infection in this population. Although this fact reflects the spread of MDR pathogens in health care facilities worldwide, several factors relating to the care of transplant donor candidates and recipients render these patients particularly prone to the acquisition of MDR bacteria and increase the likelihood of MDR infectious outbreaks in transplant units. The awareness of this high vulnerability of transplant recipients to infection leads to the more frequent use of broad-spectrum empiric antibiotic therapy, which further contributes to the selection of drug resistance. This vicious cycle is difficult to avoid and leads to a scenario of increased complexity and narrowed therapeutic options. Infection by MDR pathogens is more frequently associated with a failure to start appropriate empiric antimicrobial therapy. The lack of appropriate treatment may contribute to the high mortality occurring in transplant recipients with MDR infections. Furthermore, high therapeutic failure rates have been observed in patients infected with extensively-resistant pathogens, such as carbapenem-resistant Enterobacteriaceae, for which optimal treatment remains undefined. In such a context, the careful implementation of preventive strategies is of utmost importance to minimize the negative impact that MDR infections may have on the outcome of liver transplant recipients. This article reviews the current literature regarding the incidence and outcome of MDR infections in liver transplant recipients, and summarizes current preventive and therapeutic recommendations.

Fighting fire with fire: is it time to use probiotics to manage pathogenic bacterial diseases?

Probiotics, when considered in clinical practice, have traditionally been used for prophylaxis; however, there is growing data suggesting treatment benefits in numerous disease states. In this review, we focus on probiotics as treatment for and prevention of several acute and chronic infectious processes including Helicobacter pylori, Clostridium difficile, necrotizing enterocolitis, ventilator-associated pneumonia, vancomycin-resistant enterococci, and nonalcoholic fatty liver disease. It is inaccurate to generalize findings observed in a single probiotic species to all probiotics. This reasoning is due to the variability of colonizing abilities of native intestinal floras, probiotic or otherwise, secondary to different combinations, doses, and duration of treatments. Given these limitations, multiple animal and human studies have shown anti-inflammatory and selective antimicrobial effects of specific probiotics. Some studies suggest a role for probiotics as supplemental treatment, in combination with antibiotics, for the aforementioned disease processes. It is apparent from this review that the efficacy of probiotics is widely variable and multifaceted. More focused clinical and basic science research is necessary to better understand the treatment potential of various probiotics.