title: The emergence of vancomycin-resistant enterococcal bacteremia in hematopoietic stem cell transplant recipients.
abstract: Abstract As antimicrobial resistance increases, understanding the current epidemiology of bloodstream infections (BSIs) in hematopoietic stem cell transplant (HSCT) recipients is essential to guide empirical antimicrobial therapy. We therefore reviewed microbial etiologies, timing and outcomes of BSIs in patients who were transplanted from September 2007 to December 2011. Vancomycin-resistant enterococci (VRE) were the most common pathogens in allogeneic HSCT recipients and the fourth most common after autologous transplant. VRE did not cause any of 101 BSIs in neutropenic patients who were not receiving antibacterials, but caused 32 (55%) of 58 BSIs in neutropenic patients receiving a broad-spectrum β-lactam agent (p < 0.001). Rates of septic shock and 7-day mortality were 5% and 0% for streptococcal bacteremia, 12% and 18% for VRE bacteremia, and 20% and 14% for Gram-negative bacteremia. In conclusion, VRE bacteremia was the most common BSI in allogeneic HSCT recipients, occurred primarily in neutropenic patients receiving broad-spectrum β-lactams and was associated with poor outcomes.
authors.affiliation: Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, Weill Cornell Medical College , New York, NY , USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Satlin
authors.forename: Rosemary
authors.initials: R
authors.lastname: Soave
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Racanelli
authors.forename: Tsiporah B
authors.initials: TB
authors.lastname: Shore
authors.forename: Koen
authors.initials: K
authors.lastname: van Besien
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Walsh
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D011379:Prognosis; D012307:Risk Factors; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014640:Vancomycin / Q000494:pharmacology; D065507:Vancomycin-Resistant Enterococci
chemical_list: D014640:Vancomycin
keywords: Vancomycin-resistant enterococci; bloodstream infections; hematopoietic stem cell transplant recipients