Abstract
We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. All patients in the hematology department of the Ministry of Health Okmeydanı Training and Research Hospital, an 800-bed tertiary hospital in İstanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study. A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 ± 14.4 years (range: 17-82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancerscore of patients with hematological malignancies was 17.18 ± 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 ± 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin's lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia. Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.
Highlights
We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies
Patients were excluded if they were treated for other hematological diseases or had not been screened by rectal swab culture for VRE colonization while in the hematology ward
Fifty (39.68%) patients were colonized with VRE; the mean number of VRE colonization days per patient was 34.27 ± 13.12 days
Summary
We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly. Enterococci are part of the normal flora of humans and vertebrates They can survive under adverse conditions in various environments such as soil, water, food, and on medical devices [1]. Enterococci are found in the gastrointestinal tract, in oropharyngeal secretions, and on the skin [1] These bacteria can cause nosocomial infections in vulnerable patients colonized with vancomycin-resistant enterococci (VRE) or exposed to contaminated tools or medical personnel [2]. Patients with hematological malignancies during remission-induction chemotherapy who undergo an allogeneic hematopoietic stem cell transplant with prior conditioning chemotherapy are at risk of infection with colonizing and opportunistic microorganisms [5]
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