Preemptive antifungal therapy among neutropenic patients.

lated from sputum samples obtained from 7 patients were not considered to represent systemic infection. Five (16%) of the patients with VRE bacteremia had polymicrobial infections with Stenotrophomonas maltophilia (2 patients), Escherichia coli (1), Pseudomonas aeruginosa (1), and Staphylococcus aureus (1). Most patients (71%) were neutropenic (absolute neutrophil count, !500 cells/mL) when they developed VRE bloodstream infection or VRE infection of another site. Our data indicate that the prevalence of VRE colonization among patients with hematologic malignancies and HSCT recipients is lower than rates reported among patients awaiting liver transplantation [1, 4]. Nevertheless, a substantial portion of patients with VRE colonization developed systemic infection, especially during neutropenia [5]. Although we did not investigate infection-related mortality and length of hospitalization in this epidemiologic study, it might be prudent to consider preemptive antimicrobial therapy with agents that have activity against VRE in these high-risk febrile patients with VRE colonization during cytotoxic therapy– induced neutropenia, particularly in those with severe orointestinal mucosal erosion.