Colonization and infection with vancomycin-resistant enterococcus among patients with cancer

Vancomycin-resistant enterococci (VRE) cause substantial morbidity and mortality in immune-suppressed patients. In a retrospective review, VRE fecal colonization was documented in 4.7% (99 of 2115) of patients screened, with 5.4% of patients with leukemia, 4.9% of hematopoietic stem cell transplantation recipients, and 2.2% of patients with lymphoma being colonized. Among the 99 patients with VRE colonization, 29 (29.29%) developed bacteremia, and there were 32 episodes of VRE infection at other sites. The rate of VRE bacteremia in solid tumor patients (0.12%) was significantly lower (P ≤ .0001). VRE colonization had a negative predictive value of 99.9% and a positive predictive value of 29.3% for the development of VRE bacteremia and might help identify a high-risk subset of patients that might benefit from preemptive VRE therapy during episodes of neutropenic fever.