| Abstract: |
Background: VRE emerged in the 1990s as a significant cause of nosocomial infections. However, few studies have examined the impact of VRE bacteremia in allogeneic HSCT. We therefore reviewed 687 consecutive recipients of an allogeneic related (n=476) or unrelated (n=211) HSCT at MSKCC to determine incidence and outcome of VRE bacteremia. Methods: Retrospective review of allogeneic HSCT recipients from 1/1/94-12/31/01 for the treatment of a hematologic malignancy, bone failure, or hemoglobinopathy. All allogeneic HSCT recipients are followed for various complications, including infections. Cases of VRE bacteremia were identified from this data base and confirmed by reviewing microbiology records. Results: 67/687 (9.7%) pts developed VRE bacteremia at a median (range) of +20 (-4 to +291) days peri-transplant. 41/67 episodes occurred before neutrophil engraftment. Annual incidence of VRE was stable. Versus patients without VRE, those with VRE were older (37.3 versus 32), had more graft failure and higher 30d mortality. No significant differences were detected between two groups in transplant type or use or method of T-cell depletion. VRE was the primary or secondary cause of death in 29% of patients who developed bacteremia within the first 30d post transplant. Seven of 41 patients with early VRE received linezolid and 34 chloramphenicol +/- doxycycline. Attributable mortality was 11/34 with chloramphenicol +/- doxycycline versus 1/7 with linezolid (NS). Conclusion: VRE is a common cause of bacteremia in alloHSCT patients, particularly before engraftment. The increased rate of graft failure may be due to either the disease or its treatment. Attributable mortality is significant but may improve with newer antibiotics. Future studies are needed to determine best treatment strategy for VRE in this patient population. |
