BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) in particular has evolved as an important cause of hospital acquired infection, especially in immunocompromised hosts. METHODS: We present a complex case of a patient with relapsed acute myeloid leukemia who underwent allogenic hematopoietic stem cell transplantation complicated by persistent VRE bacteremia and meningitis. To optimize therapy, various blood and cerebrospinal fluid (CSF) samples were sent to a research laboratory for extensive susceptibility testing, pharmacokinetic analyses, and time-kill experiments. RESULTS: In vitro testing revealed resistance to all first-line treatment options and CSF sampling demonstrated sub-optimal central nervous system concentrations achieved by each antimicrobial agent administered in relation to their respective MIC value. Time-kill analyses at observed CSF concentrations confirmed the lack of bactericidal activity despite use of a four-drug combination regimen. CONCLUSIONS: This work is the first to report CSF concentrations of oritavancin and tedizolid in humans and adds to the limited data regarding in vitro susceptibility of new antimicrobial agents such as eravacycline, omadacycline, and lefamulin against VRE. Our study provides new insights into various aspects of treatment of extensively drug-resistant Enterococcus faecium meningitis and bacteremia and supports the continued pursuit of precision medicine for these challenging cases.

Despite emerging data suggesting reduced antibody responses among SOT recipients following SARS-CoV-2 vaccine, critical unanswered questions remain. The clinical implications of the reduced humoral response need to be assessed through prospective studies. Studies are likewise needed to inform which vaccine dosing strategies result in improved immunity and if such approaches maximize protection against severe infection in the vulnerable transplant population.

We present a case of a liver transplant recipient with 2 distinct SARS-CoV-2 infections, separated by 111 days without symptoms and 2 negative test results for SARS-CoV-2 infection. The clinical course suggested reinfection, and viral genomic sequencing was used to distinguish whether the later positive samples were due to SARS-CoV-2 relapse or reinfection.

Solid organ transplant (SOT) recipients appear to have higher rates of mortality from COVID-19 when compared to other populations, attributed to underlying immunosuppression and concomitant co-morbidities.1 Such findings are consistent with other respiratory viral infections that are associated with an increased risk of morbidity and mortality in immunocompromised hosts.2 Further, these patients experience prolonged SARS-CoV-2 shedding which has been linked to emergence of viral mutants. Prolonged shedding also poses a risk of transmission and requires prolonged isolation, potentially leading to delays in medical care.

There are numerous case reports and a handful of single center studies reporting on COVID‐19 in kidney transplant recipients. Most reports arise from the epicenters of where the SARS‐CoV‐2 virus was first detected such as New York City and Europe3. We in UNOS Region 1 experienced COVID‐19 weeks to a month later and questioned whether our experience was different. The programs within UNOS Region 1 have had a long history of sharing information in an attempt to mitigate the effect of viruses on our patients.