The Changing Epidemiology of Vancomycin-Resistant Enterococcus (VRE) Bacteremia in Allogeneic Hematopoietic Stem Cell Transplant (HSCT) Recipients

Abstract

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.

Bacterial bloodstream infections in the allogeneic hematopoietic cell transplant patient: new considerations for a persistent nemesis

“…66 Patients with known VRE colonization have a higher risk of developing VRE BSI than patients without VRE. 67 However, VRE surveillance has not conclusively demonstrated reduction in VRE bacteremia in HCT recipients. Surveillance for MDR organisms (including CRE and MDR Pseudomonas spp.…”

Which Multidrug-Resitant Bacteria are Emerging in Patients with Hematological Malignancies?: One-Year Report

“…Mortality is more likely in patients with comorbidities, patients over the age of 75 years, patients residing in the ICU at bacteremia onset, patients with a non-urinary tract infection bacteremia focus and patients admitted with severe sepsis [19]. VRE colonization rates among our patients (30 %) were higher than those reported among patients with hematopoietic stem cell transplantation (HSCT) (27.5 %) and among patients with cancer (4.7 %) [20,21]. The unfavorable conditions in our ward (e.g., shared toilets, housing of patients with their attendants, etc.)…”

Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011)

“…There is also evidence that vancomycin MICs at the high end of the normal range for MRSA (2 mg/L) are associated with worse outcomes than MIC of <1 mg/L. 104 Infections with VRE are prevalent in onco-hematological and HSCT patients in some countries [105][106][107][108][109][110] but, until now, infections with VISA or hVISA remain rare in this patient population. [111][112][113] Agents showing activity against some glycopeptide non-susceptible Gram-positive pathogens include linezolid, daptomycin, quinupristin/dalfopristin, tigecycline and fosfomycin, as well as the new agents telavancin and ceftaroline.…”