ABSTRACT
OBJECTIVES: We examined VRE colonization, bacteremia (VREB) incidence and outcomes within 100 days of allogeneic hematopoietic cell transplantation (HCT). METHODS: HCT recipients screened for VRE were assessed, and colonization and VREB incidence compared over time using linear regression. Cox proportional hazards models were constructed to assess the relationship between mortality, pre-HCT colonization, and underlying disease. RESULTS: Of 1492 HCT recipients, 204 (14%) patients were colonized pre-HCT, while 90 (6%) acquired colonization post-HCT. Forty-two patients (2.8%) developed VREB within 100 days post-HCT; the majority, 32 (76%), were previously colonized. The cumulative incidence of VREB was 2.9 per 10,000 patient-days. Over the study period there were no significant changes in incidence of VRE colonization or VREB despite a number of interventions (pâ¯>â¯0.1). Patients with pre-HCT colonization had increased mortality compared to non-colonized patients (HR 2.1; 95% CI: 1.5, 3.3). CONCLUSIONS: We found a low burden of VRE at our center with no significant changes observed over a 10-year study period. VRE, while responsible for substantial resource consumption from routine screening and isolation, was an infrequent cause of bacteremia.
Subject(s)
Bacteremia/epidemiology , Gram-Positive Bacterial Infections/epidemiology , Hematopoietic Stem Cell Transplantation/adverse effects , Vancomycin-Resistant Enterococci/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/mortality , Cost of Illness , Female , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/mortality , Humans , Male , Middle Aged , Proportional Hazards Models , Retrospective Studies , Risk Factors , Transplantation, Homologous/adverse effects , United States/epidemiology , Vancomycin/pharmacology , Vancomycin-Resistant Enterococci/drug effectsABSTRACT
The development of a new laboratory-developed norovirus assay provided an opportunity to assess testing patterns, incidence, and outcomes of norovirus among hematopoietic cell transplant (HCT) recipients. Clostridium difficile and norovirus tests from 1,393 HCT recipients were compared in these analyses. In this population of high-risk patients, norovirus appeared to occur seasonally, but testing was infrequent despite a correlation with more severe disease when compared with patients with C difficile infection.
