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Bone Marrow Transplant. 2014 Oct;49(10):1310-6. doi: 10.1038/bmt.2014.150. Epub 2014 Aug 11.

Risk factors for vancomycin-resistant enterococcus bacteremia and its influence on survival after allogeneic hematopoietic cell transplantation.

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Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
Division of Infectious Diseases (Transplant/Oncology), John Hopkins, Baltimore, MD, USA.
Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
Department of Pediatric Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA.


Vancomycin-resistant enterococcus (VRE) is a well-known infectious complication among immunocompromised patients. We performed a retrospective analysis to identify risk factors for the development of VRE bacteremia (VRE-B) within 15 months after allogeneic hematopoietic cell transplantation (alloHCT) and to determine its prognostic importance for other post-transplant outcomes. Eight hundred consecutive adult patients who underwent alloHCT for hematologic diseases from 1997 to 2011 were included. Seventy-six (10%) developed VRE-B at a median of 46 days post transplant. Year of transplant, higher HCT comorbidity score, a diagnosis of ALL, unrelated donor and umbilical cord blood donor were all significant risk factors on multivariable analysis for the development of VRE-B. Sixty-seven (88%) died within a median of 1.1 months after VRE-B, but only four (6%) of these deaths were attributable to VRE. VRE-B was significantly associated with worse OS (hazard ratio 4.28, 95% confidence interval 3.23-5.66, P<0.001) in multivariable analysis. We conclude that the incidence of VRE-B after alloHCT has increased over time and is highly associated with mortality, although not usually attributable to VRE infection. Rather than being the cause, this may be a marker for a complicated post-transplant course. Strategies to further enhance immune reconstitution post transplant and strict adherence to infection prevention measures are warranted.

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