Introduction: Infection with vancomycin-resistant Enterococcus (VRE) in liver transplant recipients (LTR) is associated with negative outcomes. Research Question or Hypothesis: Will the use of perioperative daptomycin prevent VRE infections in VRE-colonized LTR? Study Design: Retrospective chart review conducted from 6/2018 to 11/2022 included adult LTR who were VRE-colonized. Methods: VRE colonization was identified by VRE rectal swab or positive VRE culture prior to transplant. Analysis was separated into two groups, daptomycin vs. no daptomycin. All LTR received perioperative piperacillin-tazobactam for 24 hours. If VRE-colonized, one dose of daptomycin (6 mg/kg) is given pre- and post-operatively. Demographics, clinical characteristics, risk factors for VRE infection, and daptomycin dose were collected. The primary outcome was VRE infection at 14 and 90 days post-transplant. Secondary outcomes were acute rejection, 90-day mortality, intensive care unit (ICU) and overall length of stay (LOS), and ICU readmission. Results: There were 36 VRE-colonized LTR; 19 received daptomycin and 17 did not. Baseline characteristics and risk factors for VRE infection were similar between groups. There were more VRE infections in the no daptomycin group within 14 days post-transplant (24% vs. 0%, p=0.01), but at 90 days post-transplant there was no significant difference (29% vs 16%, p=0.43). One death occurred in the daptomycin group. ICU and overall LOS were longer in the daptomycin group (p=0.04 and p=0.10). Acute rejection and ICU readmissions were similar between groups. The average daptomycin dose was 7.1 mg/kg. Conclusion: Perioperative daptomycin reduced the rate of VRE infections in VRE-colonized LTR within 14 days post-transplant but not 90 days. Increased LOS in the daptomycin group were driven by 3 patients with VRE infections occurring after 14 days post-transplant. Recent evidence has shown that daptomycin doses greater than 9 mg/kg is associated with improved mortality. Future studies should evaluate if higher doses of perioperative daptomycin can reduce VRE infections beyond 14 days post-transplant.
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