title: Early vancomycin-resistant enterococcus (VRE) bacteremia after allogeneic bone marrow transplantation is associated with a rapidly deteriorating clinical course.
abstract: Vancomycin-resistant enterococcal (VRE) infection is a growing threat. We studied the incidence, risk factors, and clinical course of early-onset VRE bacteremia in allogeneic hematopoietic stem cell transplant recipients. We carried out a chart review of 281 allogeneic hematopoietic stem cell transplant recipients from 1997-2003, including preparative regimen, diagnosis, status of disease, graft-versus-host disease prophylaxis, antimicrobial therapy, and survival. VRE bacteremia developed in 12/281 (4.3%) recipients; 10 (3.6%) were within 21 days of transplant. Diagnoses were acute leukemia (7), NHL (2), and MDS (1). In all, 70% had refractory/relapsed disease; 30% were in remission. In total, 50% had circulating blasts. Nine of 10 had matched unrelated donors (7/9 with CD8+ T-cell depletion). The average time to positive VRE cultures was 15 days; average WBC was 0.05, and 80% had concomitant infections. Despite treatment, all patients died within 73 days of VRE bacteremia. Intra-abdominal complications were common. Causes of death included bacterial or fungal infection, multiorgan failure, VOD, ARDS, and relapse. A total of 60% of patients engrafted neutrophils, but none engrafted platelets. Early VRE bacteremia after allogeneic bone marrow transplant is associated with a rapidly deteriorating clinical course, although not always directly due to VRE. Early VRE may be a marker for the critical condition of these high-risk patients at the time of transplant.
authors.affiliation: Bone Marrow Transplantation Program and the Departments of Hematology-Oncology, Pharmacy, and Infectious Disease, Cleveland Clinic Foundation, OH 44195, USA.
authors.forename: R
authors.initials: R
authors.lastname: Avery
authors.forename: M
authors.initials: M
authors.lastname: Kalaycio
authors.forename: B
authors.initials: B
authors.lastname: Pohlman
authors.forename: R
authors.initials: R
authors.lastname: Sobecks
authors.forename: E
authors.initials: E
authors.lastname: Kuczkowski
authors.forename: S
authors.initials: S
authors.lastname: Andresen
authors.forename: S
authors.initials: S
authors.lastname: Mossad
authors.forename: J
authors.initials: J
authors.lastname: Shamp
authors.forename: J
authors.initials: J
authors.lastname: Curtis
authors.forename: J
authors.initials: J
authors.lastname: Kosar
authors.forename: K
authors.initials: K
authors.lastname: Sands
authors.forename: M
authors.initials: M
authors.lastname: Serafin
authors.forename: B
authors.initials: B
authors.lastname: Bolwell
mesh_terms: D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology / Q000401:mortality; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002423:Cause of Death; D018450:Disease Progression; D004351:Drug Resistance; D013293:Enterococcus faecalis / Q000302:isolation & purification*; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014640:Vancomycin / Q000494:pharmacology
chemical_list: D014640:Vancomycin