Vancomycin-resistant enterococcus infection in the hematopoietic stem cell transplant recipient: an overview of epidemiology, management, and prevention.

Esther Benamu,Stanley Deresinski

doi:10.12688/f1000research.11831.1

Abstract

Vancomycin-resistant enterococcus (VRE) is now one of the leading causes of nosocomial infections in the United States. Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of VRE colonization and infection. VRE has emerged as a major cause of bacteremia in this population, raising important clinical questions regarding the role and impact of VRE colonization and infection in HSCT outcomes as well as the optimal means of prevention and treatment. We review here the published literature and scientific advances addressing these thorny issues and provide a rational framework for their approach.

Highlights

Resistance to vancomycin in enterococci was first identified in isolates recovered in 1986, three decades after the introduction of this glycopeptide antibiotic[1]
We review the published literature addressing these aspects and summarize the latest advances in the prevention and treatment of invasive vancomycin-resistant enterococci (VRE) infection in the hematopoietic stem cell transplantation (HSCT) recipient
In patients with febrile neutropenia (FN), overall survival (OS) was not affected by the presence of VRE colonization. These two studies are in agreement with others[10,12] that found that pre-transplant VRE colonization had no impact on post-HSCT survival in the absence of occurrence of VRE bloodstream infection (BSI), but they contrast to the report of Zirakzadeh et al.[17], who reported that colonization was an independent risk factor for 100-day postHSCT mortality

Summary

Introduction

Resistance to vancomycin in enterococci was first identified in isolates recovered in 1986, three decades after the introduction of this glycopeptide antibiotic[1]. These two studies are in agreement with others[10,12] that found that pre-transplant VRE colonization had no impact on post-HSCT survival in the absence of occurrence of VRE BSI, but they contrast to the report of Zirakzadeh et al.[17], who reported that colonization was an independent risk factor for 100-day postHSCT mortality In their examination of the gut microbiota in HSCT patients, Taur and colleagues at the MSKCC demonstrated that microbial diversity at the time of stem cell engraftment predicts HSCT survival[58]. A meta-analysis that included 11 retrospective cohort studies available by November 2015 with a total of 1,339 patients with all daptomycin recipients receiving ≥6 mg/kg/day found no significant differences in overall crude mortality, clinical cure, microbiological cure, or incidence of relapse when compared to linezolid in the treatment of VREB121. Gentamicin, rifampin, and doxycycline have displayed potential benefit when used with linezolid, but evidence supporting linezolid combinations is sporadic and contradictory[182,183,184,185]

Conclusions

Centers for Disease Control and Prevention

PubMed Abstract

55. Serody J

Findings

92. Montecalvo MA