Vancomycin resistant enterococci (VRE) are important nosocomial pathogens which, when acquired, often cause asymptomatic colonization. Many studies have examined risk factors for colonization in the general hospitalized population. Liver transplantation patients represent an important risk group from VRE. These patients frequently develop severe, life-threatening infections with VRE following transplantation and may be at increased risk from this complication if their gastrointestinal tract is colonized with VRE before the transplant. At present no therapy exists which can rid the GI tract of VRE once it becomes colonized. This study will ascertain the prevalence, risk factors, natural history, and outcome of asymptomatic VRE colonization of the gastrointestinal tract in-patients awaiting liver transplantation at the University of Michigan. All patients older than 18 yrs on the University of Michigan Liver Transplant List will be asked to participate. Patients who consent will be interviewed by a member of the study team using a standardized questionnaire in order to document elements of medical and surgical history and demographics which have been shown to be risk factors for VRE colonization in other populations, as well as risk factors deemed relevant in the liver transplant population. Patients will have a rectal swab performed for culture for VRE. Rectal cultures and questionnaires will be repeated every 6 months while the patient is awaiting transplant in order to assess the natural history of colonization and to identify those patients who acquire VRE during the study period. Characteristics of patients colonized with VRE will be compared with those of patients not colonized in order to determine risk factors for colonization. On admission for transplantation all study patients will have a repeat rectal culture in order to identify those patients colonized with VRE at the time of their transplant. All patients, regardless of VRE status, will be followed post-transplantation for 60 days to assess outcome. Patient charts will be reviewed for assessment of operative and post-operative complications, infection, and death. Patients will have repeat rectal swabs performed weekly until discharge post-transplantation in order to assess nosocomial acquisition of VRE.
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