Early vancomycin-resistant enterococcus (VRE) bacteremia after allogeneic bone marrow transplantation is associated with a rapidly deteriorating clinical course.
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.
Avery
R
R
Bone Marrow Transplantation Program and the Departments of Hematology-Oncology, Pharmacy, and Infectious Disease, Cleveland Clinic Foundation, OH 44195, USA.
Kalaycio
M
M
Pohlman
B
B
Sobecks
R
R
Kuczkowski
E
E
Andresen
S
S
Mossad
S
S
Shamp
J
J
Curtis
J
J
Kosar
J
J
Sands
K
K
Serafin
M
M
Bolwell
B
B
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
D014640:Vancomycin