1530. Clinical Correlates of VRE Detection from the Lower Respiratory Tract Among Hematopoietic Cell Transplant Recipients
Session: Poster Abstract Session: Infections and Transplantation
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background:

Vancomycin-resistant Enterococci (VRE) are an important health-care associated infection and are associated with high rates of mortality in hematopoietic cell transplant (HCT) recipients.  We examined the role of VRE in lower tract respiratory (LRT) infections in this highly immunosuppressed population.    

Methods:

HCT recipients transplanted from 1/2004-2/2013 at the Fred Hutchinson Cancer Research Center with VRE detected from LRT specimens in the first year post-transplant were reviewed.  LRT involvement was defined as VRE detection from bronchoalveolar lavage (BAL) samples, colonization as detection from any other non-LRT anatomic site, and pneumonia when VRE was the only LRT pathogen in a patient without proven etiology for clinical and radiologic findings.  All data were abstracted from chart review and center transplant databases.

Results:

A total of 3862 patients underwent an HCT during the study period, of which 17 had VRE documented from LRT samples (15 allogeneic and 2 autologous).  E faecium was cultured in all patients, but most (10/17, [59%]) had at least one co-pathogen identified at the time of BAL.  The mean VRE CFU detected in the LRT was 34,353 (range 100 to >100,000), and VRE was the sole LRT pathogen detected in 7/17 (41%); three met criteria for VRE pneumonia.  Eight patients (47%) with LRT had no detected bacteremia, and three developed bacteremia post-LRT detection.  All patients had stool screening for VRE prior to BAL. Colonization was documented in 11/17 (65%) prior to BAL (7=stool, 2=blood, 2=urine), but six had no confirmed cultures for VRE prior to LRT detection.  Antibiotics were given to 6 patients for LRT disease and 7 others received therapy for concomitant bacteremia.  Most patients were receiving ICU-level care (10/17 [59%]) and were intubated (9/17 [52%]) at diagnosis, and nearly all patients (15/17 [88%]) died following LRT detection (median 20 days [IQR 7, 62]).

Conclusion:

Vancomycin-resistant Enterococci are detected infrequently in the lower respiratory tract among HCT recipients, and are rarely the sole cause of pneumonia.  Mortality is high among patients with VRE detected in lower respiratory tract specimens, suggesting the pathogen is an opportunist in critically-ill immunocompromised hosts.

Thomas Campbell, BS1, Zach Stednick, MPH2, Corey Casper, MD, MPH, FIDSA2,3,4, Guang-Shing Cheng, MD2,3, Sara Podczervinski, RN, MPH4, Susan Butler-Wu, PhD5 and Steven Pergam, MD, MPH2,3,4, (1)School of Medicine, University of Washington, Seattle, WA, (2)Fred Hutchinson Cancer Research Center, Seattle, WA, (3)Department of Medicine, University of Washington, Seattle, WA, (4)Seattle Cancer Care Alliance, Seattle, WA, (5)Department of Laboratory Medicine, University of Washington, Seattle, WA

Disclosures:

T. Campbell, None

Z. Stednick, None

C. Casper, None

G. S. Cheng, None

S. Podczervinski, None

S. Butler-Wu, None

S. Pergam, None

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