Weinstock David M, Conlon Mary, Iovino Christine, Aubrey Tanya, Gudiol Carlota, Riedel Elyn, Young James W, Kiehn Timothy E, Zuccotti Gianna
Adult Allogeneic Bone Marrow Transplant Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Biol Blood Marrow Transplant. 2007 May;13(5):615-21. doi: 10.1016/j.bbmt.2007.01.078. Epub 2007 Mar 23.
Bloodstream infection caused by vancomycin-resistant enterococcus (VRE) is associated with very high mortality among allogeneic hematopoietic stem cell transplant (alloHSCT) recipients. However, it remains unclear whether VRE bloodstream infection directly causes mortality in the early posttransplant period or is simply a marker of poor outcome. To determine the risk factors for VRE bloodstream infection and its effect on outcome, we followed 92 patients screened for stool colonization by VRE upon admission for alloHSCT. Patient records were reviewed to determine outcomes, including mortality and microbiologic failure. Colonization by VRE was extremely common, occurring in 40.2% of patients. VRE bloodstream infection developed in 34.2% of colonized patients by day +35, compared to 1.8% without VRE colonization (P < .01). VRE bloodstream infection was associated with a significant decrement in survival and frequent microbiologic failure, despite treatment with linezolid and/or daptomycin. Five (35.7%) of 14 patients with VRE bloodstream infection had attributable mortality or contributing mortality from the infection. Strain typing by pulsed-field gel electrophoresis identified 9 different VRE strains among the 37 colonized patients and 5 patients with different strains recovered from the stool and the blood. In conclusion, stool screening effectively identified patients at extremely high risk for VRE bloodstream infection. The high mortality of VRE in the early posttransplant period supports the use of empiric antibiotics with activity against VRE during periods of fever and neutropenia in colonized patients.
耐万古霉素肠球菌（VRE）引起的血流感染在异基因造血干细胞移植（alloHSCT）受者中与极高的死亡率相关。然而，尚不清楚VRE血流感染在移植后早期是否直接导致死亡，还是仅仅是预后不良的一个标志。为了确定VRE血流感染的危险因素及其对预后的影响，我们对92例alloHSCT入院时接受VRE粪便定植筛查的患者进行了随访。回顾患者记录以确定预后，包括死亡率和微生物学治疗失败情况。VRE定植极为常见，发生在40.2%的患者中。到+35天时，34.2%的定植患者发生了VRE血流感染，而未发生VRE定植的患者中这一比例为1.8%（P <.01）。尽管使用了利奈唑胺和/或达托霉素治疗，VRE血流感染仍与生存率显著下降和频繁的微生物学治疗失败相关。14例发生VRE血流感染的患者中有5例（35.7%）因该感染导致了可归因死亡或促成死亡。通过脉冲场凝胶电泳进行菌株分型，在37例定植患者以及5例从粪便和血液中分离出不同菌株的患者中鉴定出9种不同的VRE菌株。总之，粪便筛查有效地识别出了发生VRE血流感染风险极高的患者。移植后早期VRE的高死亡率支持在定植患者发热和中性粒细胞减少期间使用对VRE有活性的经验性抗生素。
