THE DISTRIBUTION AND DRUG-RESISTANCE OF PATHOGENS AMONG LIVER TRANSPLANT RECIPIENTS WITH GRAM-POSITIVE BACTEREMIAS

Introduction: To study the species distribution and frequency of antimicrobial resistance among Gram-positive bacteria responsible for bacteremias in liver transplant recipients. Materials and methods: Blood samples were processed by the BACTEC 9120 blood culture system. Species identification was performed using the Vitek-2 system. The drug susceptibility of pathogens was performed using the ATB FUNGUS 3 system. Results: Sixty eight episodes of Gram-positive bacteremias occurred in 51 liver recipients between January 31, 2003 and September 1, 2014. The median time to the onset of Gram-positive bacteremias was 6 days after liver transplantation and 92.6% of Gram-positive bacteremias were early-onset. The most common site of primary infection was intra-abdominal/biliary, followed by lungs. Of these 51 liver recipients with Gram-positive bacteremias, 25 (49%) died. The most common bacteria were Staphylococcus aureus (29.4%) and Enterococcus faecium (27.9%). Of these 20 Staphylococcus aureus, 90% were methicillin-resistant. The Gram-positive bacteria were highly resistant to erythromycin, penicillin and trimethoprim-sulfamethoxazole (resistance rate > 80%) and relatively susceptible to glycopeptides and oxazolidone antibiotics (resistance rate < 10%). There were 21 (30.9%) episodes of Gram-positive bacteremias without receiving appropriate antibiotic therapy. Conclusion: In liver transplantation, Gram-positive bacteria led to severe bacteremias with a high mortality rate and were resistant to the majority of commonly used antibiotics.