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Vancomycin-resistant enterococcal infections in bone marrow transplant recipients
Y Koc1, D R Snydman, D S Schenkein
1Division of Infectious Diseases, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA.
Abstract:
Vancomycin-resistant enterococci (VRE) infections have been increasingly reported in immunosuppressed individuals over the past decade. Emergence of this pathogen in the bone marrow transplantation (BMT) setting, in the form of bacteremia or positive stool cultures, is of concern because of lack of effective antimicrobial therapy. We report episodes of vancomycin-resistant E. faecium bacteremia in two patients undergoing BMT including the first case of VRE meningitis observed in this setting. Since the outcome in these patients undergoing matched unrelated donor BMT was fatal, we believe that routine screening for VRE in high risk patients should be considered. Management of VRE carrier state in BMT candidates is unclear at present.
Insights
Vancomycin-resistant Enterococci (VRE) infections are a growing concern in immunocompromised patients. This study reports fatal VRE bacteremia and meningitis in bone marrow transplant recipients, highlighting the need for VRE screening.
Area of Science:
- Infectious Diseases
- Hematology
- Transplantation Medicine
Background:
- Vancomycin-resistant Enterococci (VRE) infections are increasingly prevalent, particularly in immunocompromised populations.
- The emergence of VRE in the bone marrow transplantation (BMT) setting poses a significant challenge due to limited effective treatment options.
Observation:
- This report details two cases of vancomycin-resistant E. faecium bacteremia in patients undergoing BMT.
- Notably, one case involved the first documented instance of VRE meningitis in this patient population.
Findings:
- Both patients undergoing matched unrelated donor BMT experienced fatal outcomes.
- The study highlights the critical need for effective antimicrobial strategies against VRE.
Implications:
- Routine screening for VRE in high-risk patients, especially BMT candidates, should be considered.
- Current management strategies for VRE carrier states in BMT candidates require further clarification and development.