Early vancomycin-resistant enterococcus (VRE) bacteremia after allogeneic bone marrow transplantation is associated with a rapidly deteriorating clinical course

Vancomycin- resistant enterococcal ( VRE) infection is a growing threat. We studied the incidence, risk factors, and clinical course of early- onset VRE bacteremia in allogeneic hematopoietic stem cell transplant recipients. We carried out a chart review of 281 allogeneic hematopoietic stem cell transplant recipients from 1997 - 2003, including preparative regimen, diagnosis, status of disease, graft-versus-host disease prophylaxis, anti microbial therapy, and survival. VRE bacteremia developed in 12/ 281 ( 4.3%) recipients; 10 ( 3.6%) were within 21 days of transplant. Diagnoses were acute leukemia ( 7), NHL ( 2), and MDS ( 1). In all, 70% had refractory/ relapsed disease; 30% were in remission. In total, 50% had circulating blasts. Nine of 10 had matched unrelated donors ( 7/ 9 with CD8+ T- cell depletion). The average time to positive VRE cultures was 15 days; average WBC was 0.05, and 80% had concomitant infections. Despite treatment, all patients died within 73 days of VRE bacteremia. Intra-abdominal complications were common. Causes of death included bacterial or fungal infection, multiorgan failure, VOD, ARDS, and relapse. A total of 60% of patients engrafted neutrophils, but none engrafted platelets. Early VRE bacteremia after allogeneic bone marrow transplant is associated with a rapidly deteriorating clinical course, although not always directly due to VRE. Early VRE may be a marker for the critical condition of these high- risk patients at the time of transplant.