a Department of Medicine, Division of Infectious Diseases , University of Alberta , Edmonton , Alberta , Canada.
b Department of Medicine, Division of Gastroenterology and Hepatology , University of Alberta , Edmonton , Alberta , Canada.
Expert Rev Anti Infect Ther. 2019 May;17(5):363-373. doi: 10.1080/14787210.2019.1607297. Epub 2019 Apr 24.
: Vancomycin-resistant enterococci (VRE) colonization and subsequent infection results in increased morbidity, mortality and use of health-care resources. The burden of VRE colonization in liver transplant candidates and recipients is significant. VRE colonization is a marker of gut dysbiosis and its impact on the microbiota-liver axis, may negatively affect graft function and result in negative outcomes pre- and post-transplantation. : In this article we describe the epidemiology of VRE colonization, risk factors for VRE infection, health-care costs associated with VRE, with a focus on the impact of VRE colonization on liver transplant recipients' fecal microbiota, the therapeutic strategies for VRE decolonization and proposed pathophysiologic mechanisms of VRE colonization in liver transplant recipients. : VRE colonization results in a significant loss of bacterial microbiome diversity. This may have metabolic consequences, with low production of short-chain fatty acids which may, in turn, result in immune dysregulation. As antibiotics have failed to decolonize the gut, alternative strategies such as fecal microbiota transplantation (FMT), stimulation of intestinal antimicrobial peptides and phage therapy warrants future studies.
耐万古霉素肠球菌（VRE）定植和随后的感染会导致发病率、死亡率和医疗资源的增加。肝移植候选者和受者中 VRE 定植的负担是巨大的。VRE 定植是肠道菌群失调的标志物，其对微生物群-肝脏轴的影响可能会对移植物功能产生负面影响，并导致移植前后的不良后果。
在本文中，我们描述了 VRE 定植的流行病学、VRE 感染的危险因素、与 VRE 相关的医疗保健费用，重点是 VRE 定植对肝移植受者粪便微生物群的影响、VRE 去定植的治疗策略以及 VRE 定植在肝移植受者中的潜在病理生理机制。
VRE 定植导致细菌微生物群多样性的显著丧失。这可能会产生代谢后果，导致短链脂肪酸的产生减少，进而导致免疫失调。由于抗生素未能使肠道去定植，因此需要进一步研究替代策略，如粪便微生物群移植（FMT）、刺激肠道抗菌肽和噬菌体治疗。
