We undertook a retrospective evaluation of all consecutive enterococcal isolates between 2000 and 2011 in patients admitted to solid-organ transplant unit (STU)and hematologic malignancy-hematopoietic stem cell transplantation (SCU) at our tertiary care University Medical Center in New York.

Among 1,256 total episodes (a single enterococcal species per patient per year) the incidence over the 12-year period showed an overall decline (p≤0.041, r2=0.354; Figure 1) owing to a significant reduction in isolates from STU (p ≤0.01, r2=0.49; Figure 2), whereas, the incidence remained unchanged for isolates from SCU (Figure 1; p >0.5). There was expectedly a significant different in the source of 2,039 enterococcal isolates; abdominal, hepatobiliary (47.2%) and urine (23.1%) was prominent in STU patients, whereas urine accounted for most (59.2%) enterococcal isolates in SCU population (p<0.001). Episodes of bacteremia were comparable between the two units, SCU 16.8% and STU 16%. Enterococcus faecium was common species in both STU (73.7%) and SCU (55%; p>0.5), whereas, Enterococcus faecalis was significantly more common among SCU patient samples (39.2% vs. 21.7% in STU; p<0.001). Enterococcus faecalis was frequently isolated in soft tissue samples in SCU (73%) compared with STU (12.1%, p<0.001) and abdominal-hepatobiliary samples reveled Enterococcus faecium mostly from STU (77.2%) compared with SCU (48.5%; p<0.001).

There was an overall declining trend in the incidence of vancomycin-resistant Enterococcus (VRE) (p=0.53, r²=0.33), however, this decline was only significant in patient samples from STU (p≤0.02, r²=0.42). In STU samples, the frequency of VRE went down to 63.3% in 2006-2011 from 80.7% in 2000-2005 (p<0.001); in samples from SCU, frequency of VRE remained unchanged during these study intervals (47.7% in 2000-2005 and 51.3% during 2006-2011; p>0.5). The significant decline in VRE in patients at the solid-organ transplant unit was encouraging. In patients with hematologic malignancy and recipients of HSCT it remains unchanged in the past 12 years.

« Back to 2013 American Transplant Congress