This article is more than 5 years old. Information may no longer be current.
VRE infections increased mortality risk among HSCT recipients
Click Here to Manage Email Alerts
Enterococcal bloodstream infections are prevalent among recipients of allogeneic hematopoietic stem cell transplants and are associated with significant mortality, data from a recent study suggest.
“Mortality risk was especially significant among those infected with vancomycin-resistant strains,” Jan Vydra, MD, a visiting hematology research fellow, and Jo-Anne Young, MD, a professor of medicine at University of Minnesota, told Infectious Disease News. “Colonization with vancomycin-resistant enterococci (VRE) was confirmed to be an important risk factor for VRE bacteremia.”
Young and colleagues conducted a retrospective analysis to determine risk factors and outcome of VRE and vancomycin-sensitive enterococci (VSE) infections among 752 patients who received hematopoietic stem cell transplants (HSCTs) from 2004 to 2008 at the University of Minnesota. Among these patients, 173 were colonized with VRE throughout the 5-year study period, 25% of whom were known to be colonized with VRE before their transplants.
During the first year after transplantation, 93 patients had enterococcal bloodstream infections. Of the patients who were colonized with VRE, 14% developed a VRE bloodstream infection. Among those who were not colonized, 4% developed an infection. The cumulative incidence of VRE bloodstream infection was 6.6% and the incidence of VSE bloodstream infection was 5.7%.
Risk factors for VRE bloodstream infection included colonization with VRE, delay in engraftment and severe acute graft-versus-host disease. For both VRE and VSE, the all-cause mortality 30 days after bloodstream infection onset was 38%. VRE infections increased the mortality HR to 4.2 and VSE infections increased the mortality HR to 2.7.
“Results from a retrospective observational study like ours do not lead directly to changes in daily practice, but identify important questions that need to be addressed,” Vydra and Young said. “Effective strategies to prevent or treat colonization with VRE are lacking. Extent of direct contribution of enterococcal infections to mortality in the setting of complex medical conditions is still not known.”
Disclosure: Vydra and Young report no relevant financial disclosures.
Perspective
Back to Top
Ginna Laport, MD
The results of this study highlight the increasing incidence of VRE colonization in stem cell transplant patients. Fortunately, although the incidence of colonization is increasing, the actual development of a VRE bloodstream infection (BSI) has decreased significantly. It is alarming that 66 percent of the patients who developed an enterococcal BSI have a resistant isolate.
Patients who were colonized with VRE had a much higher incidence of developing a VRE BSI compared with patients who were not colonized. It is alarming that 66 percent of the adult patient and 31 percent of the pediatric patients who developed an enterococcal blood stream infection had vancomycin-resistant BSI which indicates the difficulty in treating this infection. This study also showed that VRE BSI was associated with inferior survival and higher all-cause mortality.
Mandatory surveillance of all hospitalized patients for VRE colonization should be considered by hospitals to decrease nosocomial spread of VRE colonization since colonization is the most significant risk factor for developing a VRE BSI. Early identification of a VRE colonized patient would cause earlier implementation of infection control measures. Such measures have been shown to decrease spread of VRE colonization and VRE infections.
Click Here to Manage Email Alerts