Risk Factors and Outcomes of Vancomycin-Resistant Enterococcus faecium Bloodstream Infection in Hematologic Malignancies and Stem Cell Transplant Recipients: A Case-Control Study.

Authors

Khuloud Aldhaheri, Jollee S T Fung, Cesilia Nishi, Jessica E Lau, Allison Mah, Alissa J Wright, Ryan J Stubbins, Marthe K Charles, Sara Belga

Published in

Open forum infectious diseases. Volume 13. Issue 10. Pages ofag627. Epub Oct 06, 2026.

Abstract

Vancomycin-resistant Enterococcus faecium (VREfm) bloodstream infection (BSI) represents a growing challenge in hematology-oncology settings. This study aimed to characterize the epidemiology, risk factors, and prognostic impact of VREfm BSI within a mixed adult hematology-oncology and transplant unit.
We conducted a retrospective matched case-control study (2014-2024). Multivariable conditional logistic regression identified factors associated with VREfm BSI, and restricted cubic spline (RCS) models assessed nonlinear exposure-response relationships between antimicrobial classes and VREfm BSI. Survival was analyzed using Kaplan-Meier curves and Cox proportional hazards regression.
VREfm BSI incidence rose from 0.02 to 0.07 per 1000 person-days (2014-2018 vs 2019-2024). A high-risk composite comprising recipients of allogeneic stem cell transplant and/or AML (adjusted OR [aOR], 3.90; 95% CI, 1.87-8.15; P < .001) and ICU admission (aOR, 5.63; 95% CI, 2.15-14.78; P < .001), were independently associated with VREfm BSI. Cumulative days of carbapenems (aOR, 1.09/day; 95% CI, 1.02-1.17; P = .013), beta-lactam/beta-lactamase inhibitors (aOR, 1.09/day; 95% CI, 1.02-1.16; P = .006), and systemic antifungals (aOR, 1.12/day; 95% CI, 1.03-1.22; P = .009) exhibited duration-dependent associations. RCS models demonstrated a nonlinear, duration-dependent association with cumulative antibiotic exposure, including antianaerobic agents (P < .001). VREfm BSI was associated with increased mortality (adjusted hazard ratio, 2.09; 95% CI, 1.63-2.66; P < .001).
VREfm BSI reflects the interplay between host susceptibility and nonlinear, duration- and spectrum-dependent antibiotic exposure pressure. This underscores the importance of antimicrobial stewardship strategies as a potential intervention to mitigate risk.

PMID:
42892792
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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