10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients

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 (p > 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.