The changing epidemiology of vancomycin-resistant Enterococcus (VRE) bacteremia in allogeneic hematopoietic stem cell transplant (HSCT) recipients.
The impact of the rising prevalence of vancomycin-resistant Enterococcus (VRE) prior to hematopoietic stem cell transplantation (HSCT) and changes in transplant techniques on risk of VREB (VRE bacteremia) early after HSCT is not known. This is a retrospective study of 247 adult patients who underwent allogeneic HSCT in the years 2008 and 2009 at the Memorial Sloan-Kettering Cancer Center. Sixty-eight of 247 (27.5%) patients were VRE colonized on pretransplant screening. VRE was the leading cause of bacteremia in the first 30 days after HSCT; 23 of 43 (53.5%) patients with positive blood cultures had VRE. Only 13 (57%) of the 23 patients with early VREB were colonized with VRE on pre-HSCT screening cultures. Mortality was directly attributable to VRE infection in 9% of patients with early VREB. VRE is emerging as the most common cause of preengraftment bacteremia in patients undergoing allogeneic HSCT, and is associated with substantial mortality. Pre-HSCT screening for VRE with stool cultures will not identify all patients who are at risk for VREB. The use of alternate agents with activity against Gram-positive bacteria for fever and neutropenia early after HSCT should be evaluated further in prospective studies.
Kamboj
Mini
M
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. Kambojm@mskcc.org
Chung
Dick
D
Seo
Susan K
SK
Pamer
Eric G
EG
Sepkowitz
Kent A
KA
Jakubowski
Ann A
AA
Papanicolaou
Genovefa
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000302:isolation & purification*; D005260:Female; D041981:Gastrointestinal Tract / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013601:T-Lymphocytes / Q000166:cytology; D013997:Time Factors; D014640:Vancomycin; D055815:Young Adult
D014640:Vancomycin