1. Bloodstream Infection Due to Vancomycin-resistant Enterococcus Is Associated With Increased Mortality After Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome: A Multicenter, Retrospective Cohort Study
- Author
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Papanicolaou, Genovefa A, Ustun, Celalettin, Young, Jo-Anne H, Chen, Min, Kim, Soyoung, Ahn, Kwang Woo, Komanduri, Krishna, Lindemans, Caroline, Auletta, Jeffery J, Riches, Marcie L, Abdel-Azim, Hisham, Ahmed, Ibrahim A, Aljurf, Mahmoud, Antin, Joseph, Ballen, Karen Kuhn, Beitinjaneh, Amer, Brown, Valerie I, Cerny, Jan, Champlin, Richard, Chao, Nelson, Chhabra, Saurabh, Dahi, Parastoo B, Daly, Andrew, Dandoy, Christopher, Dvorak, Christopher C, Forman, Stephen, Ganguly, Siddhartha, Hashmi, Shahrukh K, Kharfan-Dabaja, Mohamed A, Lazarus, Hillard, Ljungman, Per, Malone, Adriana K, Murthy, Nishihori, Taiga, Page, Kristin, Pingali, Ravi, Reddy, Vijay, Saad, Ayman, Savani, Bipin N, Seftel, Matthew, Szer, Jeffrey, Vij, Ravi, Weisdorf, Daniel, William, Basem M, Williams, Kirsten, Wirk, Baldeep, and Yared, Jean
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Cancer ,Vaccine Related ,Transplantation ,Rare Diseases ,Hematology ,Emerging Infectious Diseases ,Clinical Research ,Good Health and Well Being ,Adolescent ,Adult ,Aged ,Anti-Bacterial Agents ,Bacteremia ,Child ,Child ,Preschool ,Gram-Positive Bacterial Infections ,Hematopoietic Stem Cell Transplantation ,Humans ,Infant ,Leukemia ,Myeloid ,Acute ,Middle Aged ,Myelodysplastic Syndromes ,Retrospective Studies ,Transplantation Conditioning ,Vancomycin ,Vancomycin-Resistant Enterococci ,Young Adult ,vancomycin-resistant Enterococcus ,bacteremia ,hematopoietic stem cell transplantation ,mortality ,CIBMTR® Infection and Immune Reconstitution Working Committee ,Biological Sciences ,Medical and Health Sciences ,Microbiology ,Clinical sciences - Abstract
BackgroundWe examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database.MethodsAdult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups-VRE BSI, non-VRE BSI, without BSI-according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year.ResultsOf 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2-3.7) and increased NRM (RR, 4.7; 99% CI, 3.6-6.2) (P < .0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, - mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P < .001 for all variables).ConclusionsVRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.
- Published
- 2019