Staphylococcus aureus

DONOR: a male with history of non-medical injection drug use with methicillin-resistant S. aureus (MRSA) endocarditis (positive blood cultures+autopsy) who died of intracerebral hemorhage due to septic emboli; declared brain dead within 24 hours from admission. Received 2 doses of vancomycin and blood cultures obtained 3 days before organ recovery were negative. RECIPIENTS: LIVER: Intraoperative graft biopsy was culture negative but blood taken 3 hrs post transplantation was positive for MRSA. He was receiving daptomycin for cellulitis around the time of transplantation and this was continued for 14 days at 4mg/kg/day, with subsequent negative blood cultures. Re-admitted on POD+58 with fever and chills; proven MRSA bacteremia with no evidence of hepatic abscess or valvular vegetation, treated with a 6- week course of vancomycin with resolution of symptoms and negative blood cultures. LUNG RECIPIENT: Intraoperative routine lung biopsy positive for MRSA. Vancomycin initiated at the time of transplantation. Blood cultures collected on POD+6 were positive for MRSA. BAL cultures also MRSA positive during the subsequent 6 weeks, with no symptoms. He completed 9 weeks of antibiotic therapy. BAL negative on POD+ 99. Six months after transplant he presented with MRSA pneumonia (BAL culture positive for MRSA) cured with 4 weeks of vancomycin . PANCREAS AND LEFT KIDNEY RECIPIENT: Surveillance blood cultures negative. Five doses of vancomycin prophylaxis without transmission. RIGHT KIDNEY RECIPIENT: Surveillance blood cultures negative. Five doses of vancomycin prophylaxis without transmission.