Colonization, Bloodstream Infection, and Mortality Caused by Vancomycin-Resistant Enterococcus Early after Allogeneic Hematopoietic Stem Cell Transplant

Autor: Tanya Aubrey, James W. Young, Mary Conlon, David M. Weinstock, Elyn Riedel, Carlota Gudiol, Timothy E. Kiehn, Gianna Zuccotti, Christine Iovino
Rok vydání: 2007
Předmět:
Male
Antibiotics
Bacteremia
medicine.disease_cause
chemistry.chemical_compound
Feces
Risk Factors
Vancomycin-resistant enterococcus
Mass Screening
Cross Infection
biology
Hematopoietic Stem Cell Transplantation
Hematology
Middle Aged
Prognosis
Screening
Female
medicine.drug
Adult
medicine.medical_specialty
medicine.drug_class
New York
Bloodstream infection
Neutropenia
Internal medicine
medicine
Humans
Transplantation
Homologous
Vancomycin-resistant Enterococcus
Allogeneic
Survival analysis
Aged
Retrospective Studies
Transplantation
business.industry
Vancomycin Resistance
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
medicine.disease
biology.organism_classification
Survival Analysis
chemistry
Enterococcus
Linezolid
Immunology
Stem cell transplant
Daptomycin
business
Zdroj: Biology of Blood and Marrow Transplantation. 13(5):615-621
ISSN: 1083-8791
DOI: 10.1016/j.bbmt.2007.01.078
Popis: 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.
Databáze: OpenAIRE
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