Pretransplant Gut Colonization with Intrinsically Vancomycin-Resistant Enterococci (E. gallinarum and E. casseliflavus) and Outcomes of Allogeneic Hematopoietic Cell Transplantation

Armin Rashidi; Maryam Ebadi; Robin R Shields-Cutler; Todd E DeFor; Gabriel A Al-Ghalith; Patricia Ferrieri; Jo-Anne H Young; Gary M Dunny; Dan Knights; Daniel J Weisdorf

doi:10.1016/j.bbmt.2018.01.025

Pretransplant Gut Colonization with Intrinsically Vancomycin-Resistant Enterococci (E. gallinarum and E. casseliflavus) and Outcomes of Allogeneic Hematopoietic Cell Transplantation

Biol Blood Marrow Transplant. 2018 Jun;24(6):1260-1263. doi: 10.1016/j.bbmt.2018.01.025. Epub 2018 Jan 31.

Authors

Affiliations

¹ Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: [email protected].
² Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
³ BioTechnology Institute, College of Biological Sciences, University of Minnesota, Minnesota.
⁴ Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
⁵ Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.
⁶ Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
⁷ Department of Microbiology and Immunology, University of Minnesota, Minneapolis, Minnesota.
⁸ Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.

Abstract

Pretransplant gut colonization with intrinsically vancomycin-resistant enterococci (iVRE) (Enterococcus gallinarum and Enterococcus casseliflavus) is uncommon and with unknown clinical impact. In a matched-pairs analysis of patients with versus without iVRE colonization (n = 18 in each group), we demonstrated significantly higher 2-year overall survival (86% [95% confidence interval, 52% to 96%] versus 35% [95% confidence interval, 8% to 65]; P <.01) and lower nonrelapse mortality (P <.01) among colonized patients. Putative metabolomes differentiated iVRE from E. faecalis/faecium and may contribute to a healthier gut microbiome in iVRE-colonized patients.

Keywords: Allogeneic; Biosynthetic; Colonization; Enterococcus; Vancomycin.

MeSH terms

Gastrointestinal Microbiome*
Hematopoietic Stem Cell Transplantation / methods*
Hematopoietic Stem Cell Transplantation / mortality
Humans
Matched-Pair Analysis
Metabolome
Recurrence
Survival Rate
Transplantation, Homologous / methods
Treatment Outcome
Vancomycin-Resistant Enterococci*

Grants and funding

UL1 TR002494/TR/NCATS NIH HHS/United States