Vancomycin-resistant Enterococci: Differing Rates and Patterns of Colonization in Liver vs. Non-Liver Solid Organ Transplant
Bibliographic record
Abstract
Vancomycin-resistant enterococci (VRE) colonization in liver transplant recipients is associated with negative outcomes such as VRE infection, longer hospitalizations, and death. Less is known about VRE colonization in non-liver solid organ transplant (SOT) recipients. The purpose of this study was to describe the epidemiology of VRE colonization in non-liver SOT patients in one major Canadian organ transplant center and compare it to the liver transplant population. Single-center retrospective review of SOT between 2005 and 2015. Cross-referencing of our provincial infection control and SOT databases identified SOT patients who were colonized with VRE during their peri-transplant period. This period was defined as 3 months before to 1 year after transplant. All surveillance cultures, whether positive or negative, and all clinical cultures positive for VRE, were obtained. Patients were considered VRE colonized pre-transplant if they had a positive culture before, or within 48 hours of their transplant. During the study period, there were 663 liver and 1617 non-liver transplants, of which 130 (20%) and 149 (9%) were VRE colonized, respectively (P < 0.001). The rate of VRE colonization in the non-liver group differed by specific organ including: lung/heart–lung 84/437 (19%), heart 17/240 (7%), kidney 36/854 (4%), and miscellaneous 11/86 (13%). The pattern of colonization was different between organs, as depicted in the figure (P < 0.001). Forty-nine percent of liver patients were already colonized before transplant, compared with 17% in non-liver. In all organs, there was a high incidence of new VRE colonization in the immediate post-transplant period. The rate and pattern of VRE colonization differ by transplant organ. Overall rates approach those in the liver cohort for lung/heart–lung, despite no manipulation of the biliary tract, or breach of the peritoneum. Future study should determine risk factors for VRE colonization in non-liver SOT and assess if colonization is associated with worse outcomes in non-liver patients. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".