Incidence and outcome of vancomycin-resistant enterococcal bacteremia following autologous peripheral blood stem cell transplantation

A retrospective evaluation of 321 consecutive recipients of high-dose chemo therapy (HDC) and autologous peripheral blood stem cell transplantation (PB SCT) was conducted to ascertain the incidence and outcome of vancomycin-res istant enterococcal (VRE) bacteremia. Ten patients developed VRE bacteremia at a median of 6 days following PBSCT, Nine isolates were Enterococcus fae cium and one was E, faecalis, The median duration of bacteremia was 5 days. The central venous catheter was removed in seven individuals. Nine patient s were treated with a variety of antimicrobial agents including quinupristi n-dalfopristin, chloramphenicol, doxycycline, oral bacitracin, co-trimoxazo le, and nitrofurantoin, Bacteremia resolved without adverse sequelae in sev en patients. Two individuals who died of other causes had persistent or rel apsed bacteremia at the time of death. An additional patient suffered multi ple relapses of VRE bacteremia and died as a result of VRE endocarditis 605 days following PBSCT, Mortality as a direct result of VRE bacteremia was 1 0% in this series. The optimal type and duration of treatment of VRE bacter emia has not been clearly defined, Therefore, we perform weekly stool surve illance cultures for VRE in our hospitalized transplant population and appl y strict barrier precautions in those individuals in whom stool colonizatio n has been identified. Furthermore, the empiric use of vancomycin has been restricted.