title: Vancomycin-Resistant Enterococcus Colonization and Bacteremia and Hematopoietic Stem Cell Transplantation Outcomes.
abstract: The association between pre-hematopoietic stem cell transplantation (HSCT) vancomycin-resistant Enterococcus (VRE) colonization, HSCT-associated VRE bacteremia, and HSCT mortality is disputed. We studied 161 consecutive patients with acute leukemia who underwent HSCT at our hospital between 2006 and 2014, of whom 109 also received leukemia induction/consolidation on our unit. All inpatients had weekly VRE stool surveillance. Pre-HSCT colonization was not associated with increases in HSCT mortality but did identify a subgroup of HSCT recipients with a higher risk for VRE bacteremia and possibly bacteremia from other organisms. The major risk factor for pre-HSCT colonization was the number of hospital inpatient days between initial admission for leukemia and HSCT. One-third of evaluable patients colonized before HSCT were VRE-culture negative on admission for HSCT; these patients had an increased risk for subsequent VRE stool surveillance positivity but not VRE bacteremia. Molecular typing of VRE isolates obtained before and after HSCT showed that VRE strains frequently change. Postengraftment VRE bacteremia was associated with a much higher mortality than pre-engraftment VRE bacteremia. Pre-engraftment bacteremia from any organism was associated with an alternative donor and resulted in an increase in hospital length of stay and cost. Mortality was similar for pre-engraftment VRE bacteremia and pre-engraftment bacteremia due to other organisms, but mortality associated with post-engraftment VRE bacteremia was higher and largely explained by associated severe graft-versus-host disease and relapsed leukemia. These data emphasize the importance of distinguishing between VRE colonization before HSCT and at HSCT, between pre-engraftment and postengraftment VRE bacteremia, and between VRE bacteremia and bacteremia from other organisms.
authors.affiliation: Intermountain Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah. Electronic address: clyde.ford@imail.org.
authors.forename: Clyde D
authors.initials: CD
authors.lastname: Ford
authors.affiliation: Division of Infectious Diseases and Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah.
authors.forename: Michaela A
authors.initials: MA
authors.lastname: Gazdik
authors.affiliation: Division of Infectious Diseases and Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah; Division of Infectious Diseases, University of Utah, Salt Lake City, Utah.
authors.forename: Bert K
authors.initials: BK
authors.lastname: Lopansri
authors.affiliation: Division of Infectious Diseases and Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah; Division of Infectious Diseases, University of Utah, Salt Lake City, Utah.
authors.forename: Brandon
authors.initials: B
authors.lastname: Webb
authors.affiliation: Intermountain Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Mitchell
authors.affiliation: Division of Infectious Diseases and Clinical Epidemiology, LDS Hospital, Salt Lake City, Utah.
authors.forename: Jana
authors.initials: J
authors.lastname: Coombs
authors.affiliation: Intermountain Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah.
authors.forename: Daanish
authors.initials: D
authors.lastname: Hoda
authors.affiliation: Intermountain Blood and Marrow Transplant Program, LDS Hospital, Salt Lake City, Utah.
authors.forename: Finn Bo
authors.initials: FB
authors.lastname: Petersen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D000069196:Gastrointestinal Microbiome; D006086:Graft vs Host Disease / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000382:microbiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D006801:Humans; D016867:Immunocompromised Host; D007938:Leukemia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D020713:Vancomycin Resistance; D055815:Young Adult
keywords: Bacteremia; Hematopoietic stem cell transplantation; Vancomycin-resistant Enterococcus