Colonization, bloodstream infection, and mortality caused by vancomycin-resistant enterococcus early after allogeneic hematopoietic stem cell transplant Journal Article

Authors: Weinstock, D. M.; Conlon, M.; Iovino, C.; Aubrey, T.; Gudiol, C.; Riedel, E.; Young, J. W.; Kiehn, T. E.; Zuccotti, G.
Article Title: Colonization, bloodstream infection, and mortality caused by vancomycin-resistant enterococcus early after allogeneic hematopoietic stem cell transplant
Abstract: Bloodstream infection caused by vancomycin-resistant enterococcus (VRE) is associated with very high mortality among allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. However, it remains unclear whether VRE bloodstream infection directly causes mortality in the early posttransplant period or is simply a marker of poor outcome. To determine the risk factors for VRE bloodstream infection and its effect on outcome, we followed 92 patients screened for stool colonization by VRE upon admission for alloHSCT. Patient records were reviewed to determine outcomes, including mortality and microbiologic failure. Colonization by VRE was extremely common, occurring in 40.2% of patients. VRE bloodstream infection developed in 34.2% of colonized patients by day +35, compared to 1.8% without VRE colonization (P < .01). VRE bloodstream infection was associated with a significant decrement in survival and frequent microbiologic failure, despite treatment with linezolid and/or daptomycin. Five (35.7%) of 14 patients with VRE bloodstream infection had attributable mortality or contributing mortality from the infection. Strain typing by pulsed-field gel electrophoresis identified 9 different VRE strains among the 37 colonized patients and 5 patients with different strains recovered from the stool and the blood. In conclusion, stool screening effectively identified patients at extremely high risk for VRE bloodstream infection. The high mortality of VRE in the early posttransplant period supports the use of empiric antibiotics with activity against VRE during periods of fever and neutropenia in colonized patients. © 2007 American Society for Blood and Marrow Transplantation.
Keywords: adult; controlled study; treatment outcome; aged; middle aged; survival analysis; survival rate; retrospective studies; transplantation, homologous; acute granulocytic leukemia; major clinical study; mortality; neutropenia; drug efficacy; multiple myeloma; risk factors; mass screening; stem cell transplant; hematopoietic stem cell transplantation; chronic myeloid leukemia; medical record review; bacterial strain; risk factor; acute lymphoblastic leukemia; high risk patient; hodgkin disease; risk assessment; fever; myelodysplastic syndrome; nonhodgkin lymphoma; whole body radiation; statistical significance; screening; graft versus host reaction; allogeneic hematopoietic stem cell transplantation; hospital admission; bacteremia; gentamicin; enterococcus; vancomycin resistance; bacterial colonization; bloodstream infection; vancomycin resistant enterococcus; linezolid; vancomycin; screening test; new york; drug treatment failure; chronic lymphatic leukemia; bacterium identification; antibiotic sensitivity; feces; infection risk; cross infection; vancomycin-resistant enterococcus; enterococcal infection; feces analysis; pulsed field gel electrophoresis; prolymphocytic leukemia; allogeneic; ampicillin; daptomycin
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 13
Issue: 5
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2007-05-01
Start Page: 615
End Page: 621
Language: English
DOI: 10.1016/j.bbmt.2007.01.078
PUBMED: 17448922
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 28" - "Export Date: 17 November 2011" - "CODEN: BBMTF" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Tanya Aubrey
    2 Aubrey
  2. Christine Scura Iovino
    5 Iovino
  3. James W Young
    279 Young
  4. Timothy E Kiehn
    78 Kiehn
  5. Mary K Conlon
    2 Conlon