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Infections

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Bone Marrow Transplantation volume 38, pages 813–819 (2006)Cite this article

Abstract

Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial bloodstream infections (BSI) owing to resistant organisms. Data describing the outcomes of vancomycin-resistant enterococcal (VRE) BSI in this patient population are limited. We performed a retrospective cohort study of all cases of VRE BSI that occured between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital. There were 68 episodes of VRE BSI in 60 patients with acute (53%) or chronic (8%) leukemia, non-Hodgkin's lymphoma (22%) or other malignant hematologic disorders (17%). A total of 13, 32 and 32% were recipients of autologous, related and matched-unrelated transplants, respectively. Forty-two of allograft recipients had active acute graft-versus-host disease (GVHD) and 32% chronic GVHD. Only 57% were neutropenic, 52% had refractory/relapsed malignancy and 60% had end organ dysfunction with a median APACHE II score of 17. Median survival after VRE BSI was 19 days. Pneumonia, receipt of anti-fungal drugs and low APACHE II score at the time of the VRE BSI remained significant risk factors for death on multivariable analysis. Our analysis suggests that in patients with hematological malignancies or HSCT, VRE may not have the behavior of a virulent pathogen. VRE BSI may simply be a marker of these patients’ already existing critical medical condition.

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Acknowledgements

We thank Victoria J Fraser MD, Cherie Hill and Stacey Leimbach for their indispensable assistance on this project. This work was supported by a grant from the Centers of Disease Control and Prevention (1W01C000333-02).

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St Louis, MO, USA

    E R Dubberke, J F DiPersio & H J Khoury

  2. Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO, USA

    E R Dubberke & P Georgantopoulos

  3. Barnes-Jewish Hospital, St Louis, MO, USA

    J M Hollands & K Augustin

  4. Division of Oncology, Section Leukemia and Bone Marrow Transplantation, Washington University School of Medicine, St Louis, MO, USA

    J F DiPersio & H J Khoury

  5. School of Public Health, St Louis University, St Louis, MO, USA

    L M Mundy

  6. The Jonathan Lax Treatment Center, Philadelphia, PA, USA

    L M Mundy

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  1. E R Dubberke
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Correspondence to E R Dubberke.

Additional information

Preliminary data was presented in part at the 2006 BMT Tandem Meetings, Honolulu, HI.

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Dubberke, E., Hollands, J., Georgantopoulos, P. et al. Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?. Bone Marrow Transplant 38, 813–819 (2006). https://doi.org/10.1038/sj.bmt.1705530

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