Early vancomycin-resistant enterococcus (VRE) bacteremia after allogeneic bone marrow transplantation is associated with a rapidly deteriorating clinical course

R. Avery, M. Kalaycio, B. Pohlman, R. Sobecks, E. Kuczkowski, S. Andresen, S. Mossad, J. Shamp, J. Curtis, J. Kosar, K. Sands, M. Serafin, B. Bolwell

Research output: Contribution to journalReview articlepeer-review

Abstract

Vancomycin-resistant enterococcal (VRE) infection is a growing threat. We studied the incidence, risk factors, and clinical course of early-onset VRE bacteremia in allogeneic hematopoietic stem cell transplant recipients. We carried out a chart review of 281 allogeneic hematopoietic stem cell transplant recipients from 1997-2003, including preparative regimen, diagnosis, status of disease, graft-versus-host disease prophylaxis, antimicrobial therapy, and survival. VRE bacteremia developed in 12/281 (4.3%) recipients; 10 (3.6%) were within 21 days of transplant. Diagnoses were acute leukemia (7), NHL (2), and MDS (1). In all, 70% had refractory/relapsed disease; 30% were in remission. In total, 50% had circulating blasts. Nine of 10 had matched unrelated donors (7/9 with CD8+ T-cell depletion). The average time to positive VRE cultures was 15 days; average WBC was 0.05, and 80% had concomitant infections. Despite treatment, all patients died within 73 days of VRE bacteremia. Intra-abdominal complications were common. Causes of death included bacterial or fungal infection, multiorgan failure, VOD, ARDS, and relapse. A total of 60% of patients engrafted neutrophils, but none engrafted platelets. Early VRE bacteremia after allogeneic bone marrow transplant is associated with a rapidly deteriorating clinical course, although not always directly due to VRE. Early VRE may be a marker for the critical condition of these high-risk patients at the time of transplant.

Original languageEnglish (US)
Pages (from-to)497-499
Number of pages3
JournalBone marrow transplantation
Volume35
Issue number5
DOIs
StatePublished - Mar 2005
Externally publishedYes

Keywords

  • Allogeneic bone marrow transplant
  • Toxicity
  • Vancomycin-resistant enterococcal infection

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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