{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T18:05:54Z","timestamp":1768154754569,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T00:00:00Z","timestamp":1628985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>This study aimed to investigate the incidence of enterococcal infections and determine risk factors associated with enterococcal bloodstream infection (BSI) within the first year post-liver transplantation (LTx). We included 321 adult liver transplant recipients transplanted from 2011 to 2019 in a prospective cohort study. Cumulative incidence of enterococcal infections and risk factors associated with BSI were investigated in a competing risk model and time-updated Cox models, respectively. A total of 223 enterococcal infections were identified in 89 recipients. The cumulative incidences of first enterococcal infection and first enterococcal BSI were 28% (95% CI (23\u201333)) and 11% (CI (7\u201314)), respectively. Risk factors associated with enterococcal BSI were previous infections in the biliary tract (HR, 33; CI (15\u201374); p &lt; 0.001), peritoneum (HR, 8.1; CI (3\u201323); p &lt; 0.001) or surgical site (HR, 5.5; CI (1.4\u201322); p = 0.02), recipient age (HR per 10 years increase, 1.2; CI (1.03\u20131.6); p = 0.03), and cold ischemia time (HR per one hour increase, 1.2; CI (1.1\u20131.3); p &lt; 0.01). Enterococcal infections are highly prevalent the first year post-LTx, and recipients with enterococcal infections in the biliary tract, peritoneum, or surgical site are at increased risk of BSI. These findings may have implications for the choice of empiric antibiotics early post-LTx.<\/jats:p>","DOI":"10.3390\/microorganisms9081740","type":"journal-article","created":{"date-parts":[[2021,8,15]],"date-time":"2021-08-15T22:51:27Z","timestamp":1629067887000},"page":"1740","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Enterococcal Infections the First Year after Liver Transplantation\u2014A Prospective Cohort Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1496-8859","authenticated-orcid":false,"given":"Daniel B.","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3909-0643","authenticated-orcid":false,"given":"Dina L.","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas D.","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"},{"name":"Department of Cardiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas A.","family":"Rostved","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8699-9956","authenticated-orcid":false,"given":"Jenny D.","family":"Knudsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne D.","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"},{"name":"Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,8,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1038\/nrgastro.2013.88","article-title":"Liver transplantation: Past, present and future","volume":"10","author":"Zarrinpar","year":"2013","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/21505594.2016.1139279","article-title":"Bloodstream infections after solid-organ transplantation","volume":"7","author":"Kritikos","year":"2016","journal-title":"Virulence"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/j.1399-3062.2008.00315.x","article-title":"Infectious complications in living-donor liver transplant recipients: A 9-year single-center experience","volume":"10","author":"Kim","year":"2008","journal-title":"Transpl. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e159","DOI":"10.1093\/cid\/ciz1113","article-title":"Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss Transplant cohort study","volume":"71","author":"Stampf","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1002\/lt.21991","article-title":"Microbial epidemiology and outcome of bloodstream infections in liver transplant recipients: An analysis of 259 episodes","volume":"16","author":"Bert","year":"2010","journal-title":"Liver Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/tid.12168","article-title":"Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss Transplant Cohort Study","volume":"16","author":"Bucheli","year":"2013","journal-title":"Transpl. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"421","DOI":"10.4161\/viru.21282","article-title":"Intrinsic and acquired resistance mechanisms in enterococcus","volume":"3","author":"Hollenbeck","year":"2012","journal-title":"Virulence"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1053\/jlts.2001.20784","article-title":"Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients","volume":"7","author":"Patel","year":"2001","journal-title":"Liver Transplant."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S50","DOI":"10.1111\/j.1600-6143.2009.02893.x","article-title":"Multiply resistant gram-positive bacteria: Vancomycin-resistant enterococcus in solid organ transplant recipients","volume":"9","year":"2009","journal-title":"Am. J. Transplant."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1111\/j.1399-0012.2005.00362.x","article-title":"Consequences of vancomycin-resistant Enterococcus in liver transplant recipients: A matched control study","volume":"19","author":"Gearhart","year":"2005","journal-title":"Clin. Transplant."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13756-020-0683-3","article-title":"Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study","volume":"9","author":"Dubler","year":"2020","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jiph.2018.08.011","article-title":"Epidemiological study of secondary bloodstream infections: The forgotten issue","volume":"12","author":"Sante","year":"2018","journal-title":"J. Infect. Public Health"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2766","DOI":"10.1016\/j.transproceed.2019.02.064","article-title":"Impact of Enterococcal Bacteremia in liver transplant recipients","volume":"51","author":"Kim","year":"2019","journal-title":"Transplant. Proc."},{"key":"ref_14","unstructured":"Lamm, L.U., and Madsen, M. Scandia transplant. Nord. Med., 109, 317\u2013328."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end-stage liver disease","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Voldstedlund, M., Haarh, M., and M\u00f8lbak, K. (2014). The danish microbiology database (MIBA) 2010 to 2013. Eurosurveillance, 19.","DOI":"10.2807\/1560-7917.ES2014.19.1.20667"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.ajic.2008.03.002","article-title":"CDC\/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting","volume":"36","author":"Horan","year":"2008","journal-title":"Am. J. Infect. Control"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2601","DOI":"10.1056\/NEJMra064928","article-title":"Infection in solid-organ transplant recipients","volume":"357","author":"Fishman","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"ref_19","unstructured":"(2020, May 01). A Package for Survival Analysis in R. Available online: https:\/\/CRAN.R-project.org\/package=survival."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1186\/s12879-021-06224-2","article-title":"Bacterial and fungal bloodstream infections in pediatric liver and kidney transplant recipients","volume":"21","author":"Wareham","year":"2021","journal-title":"BMC Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s10096-020-04074-5","article-title":"Poor outcomes of early recurrent post-transplant bloodstream infection in living-donor liver transplant recipients","volume":"40","author":"Kim","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"527","DOI":"10.4097\/kjae.2015.68.6.527","article-title":"Postreperfusion syndrome during liver transplantation","volume":"68","author":"Jeong","year":"2015","journal-title":"Korean J. Anesthesiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1097\/TP.0000000000002246","article-title":"Recipient age and mortality after liver transplantation: A population-based cohort study","volume":"102","author":"Gil","year":"2018","journal-title":"Transplantation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1136\/pgmj.2007.064683","article-title":"Biliary tract infection and bacteraemia: Presentation, structural abnormalities, causative organisms and clinical outcomes","volume":"83","author":"Melzer","year":"2007","journal-title":"Postgrad. Med. J."},{"key":"ref_25","first-page":"145749691773118","article-title":"The occurrence of Enterococcus faecium and faecalis is significantly associated with anastomotic leakage after pancreaticoduodenectomy","volume":"107","author":"Belmouhand","year":"2017","journal-title":"Scand. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1186\/2049-2618-2-35","article-title":"Intestinal anastomotic injury alters spatially defined microbiome composition and function","volume":"2","author":"Shogan","year":"2014","journal-title":"Microbiome"}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/8\/1740\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:46:25Z","timestamp":1760165185000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/8\/1740"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,15]]},"references-count":26,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8]]}},"alternative-id":["microorganisms9081740"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms9081740","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,15]]}}}