title: The clinical impact of vancomycin-resistant Enterococcus colonization and bloodstream infection in patients undergoing autologous transplantation.
abstract: BACKGROUND
  Although several studies have documented adverse outcomes for vancomycin-resistant Enterococcus (VRE) colonization and infection in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients, data are inadequate for patients undergoing autologous (auto-)HSCT.
  
  
  METHODS
  We conducted a retrospective cohort study of 300 consecutive patients receiving an auto-HSCT between 2006 and 2014. Patients had stool cultures for VRE on admission and weekly during hospitalization.
  
  
  RESULTS
  Thirty-six percent of patients had VRE gastrointestinal (GI) colonization and 3% developed a VRE bloodstream infection (BSI), all of whom were colonized. VRE strain typing of BSI isolates showed that some patients shared identical patterns. Rates of colonization and BSI in colonized patients were similar to simultaneous patients undergoing allo-HSCT, except that the latter had a higher rate of colonization at admission. A diagnosis of lymphoma was associated with an increased risk of colonization. VRE BSI was associated with longer lengths of stay and possibly higher costs, but no decrease in overall survival, and colonized patients had no VRE infections during the year following discharge. Repeat stool cultures in patients subsequently undergoing allo-HSCT suggested that most, if not all, VRE-positive auto-HSCT patients lose their detectable GI colonization within a few months of discharge.
  
  
  CONCLUSIONS
  VRE colonization is frequent but carries a low risk for infection in patients undergoing auto-HSCT. However, these patients can serve as reservoirs for transmission to higher risk patients. Moreover, patients may remain colonized if proceeding to an allo-HSCT shortly after auto-HSCT, potentially increasing the risk of the allogeneic procedure.
authors.affiliation: Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Ford
authors.affiliation: Division of Infectious Diseases, LDS Hospital, Salt Lake City, Utah, USA.|Division of Infectious Diseases, The University of Utah, Salt Lake City, Utah, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Lopansri
authors.affiliation: Division of Infectious Diseases, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Gazdik
authors.affiliation: Statistical Data Center, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: G L
authors.initials: GL
authors.lastname: Snow
authors.affiliation: Division of Infectious Diseases, LDS Hospital, Salt Lake City, Utah, USA.|Division of Infectious Diseases, The University of Utah, Salt Lake City, Utah, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Webb
authors.affiliation: Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Konopa
authors.affiliation: Intermountain Acute Leukemia and Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah, USA.
authors.forename: F B
authors.initials: FB
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D016983:Enterococcus / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014182:Transplantation, Autologous; D020713:Vancomycin Resistance; D055815:Young Adult
keywords: bacteremia; bloodstream infection; colonization; hematopoietic stem cell transplant; immunosuppression; vancomycin-resistant Enterococcus