The clinical impact of vancomycin-resistant Enterococcus colonization and bloodstream infection in patients undergoing autologous transplantation

• Published in: Transplant infectious disease Vol. 17; no. 5; pp. 688 - 694
• Main Authors: Ford, C.D., Lopansri, B.K., Gazdik, M.A., Snow, G.L., Webb, B.J., Konopa, K.L., Petersen, F.B.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.10.2015; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; bacteremia; Bacteremia - diagnosis; Bacteremia - epidemiology; Bacteremia - etiology; Bacteremia - immunology; bloodstream infection; colonization; Enterococcus - isolation & purification; Feces - microbiology; Female; Gram-Positive Bacterial Infections - diagnosis; Gram-Positive Bacterial Infections - epidemiology; Gram-Positive Bacterial Infections - etiology; Gram-Positive Bacterial Infections - immunology; hematopoietic stem cell transplant; Hematopoietic Stem Cell Transplantation; Humans; immunosuppression; Infections; Male; Middle Aged; Proportional Hazards Models; Retrospective Studies; Risk Factors; Transplantation, Autologous; Transplants & implants; Vancomycin Resistance; vancomycin-resistant Enterococcus; Young Adult; immunosuppression; bloodstream infection; colonization; vancomycin-resistant Enterococcus; bacteremia; hematopoietic stem cell transplant
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12433

Background Although several studies have documented adverse outcomes for vancomycin‐resistant Enterococcus (VRE) colonization and infection in allogeneic hematopoietic stem cell transplantation (allo‐HSCT) recipients, data are inadequate for patients undergoing autologous (auto‐)HSCT. Methods We conducted a retrospective cohort study of 300 consecutive patients receiving an auto‐HSCT between 2006 and 2014. Patients had stool cultures for VRE on admission and weekly during hospitalization. Results Thirty‐six percent of patients had VRE gastrointestinal (GI) colonization and 3% developed a VRE bloodstream infection (BSI), all of whom were colonized. VRE strain typing of BSI isolates showed that some patients shared identical patterns. Rates of colonization and BSI in colonized patients were similar to simultaneous patients undergoing allo‐HSCT, except that the latter had a higher rate of colonization at admission. A diagnosis of lymphoma was associated with an increased risk of colonization. VRE BSI was associated with longer lengths of stay and possibly higher costs, but no decrease in overall survival, and colonized patients had no VRE infections during the year following discharge. Repeat stool cultures in patients subsequently undergoing allo‐HSCT suggested that most, if not all, VRE‐positive auto‐HSCT patients lose their detectable GI colonization within a few months of discharge. Conclusion VRE colonization is frequent but carries a low risk for infection in patients undergoing auto‐HSCT. However, these patients can serve as reservoirs for transmission to higher risk patients. Moreover, patients may remain colonized if proceeding to an allo‐HSCT shortly after auto‐HSCT, potentially increasing the risk of the allogeneic procedure.