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 | Zendy

Genovefa A. Papanicolaou | Zendy; Celalettin Üstün | Zendy; JoAnne H. Young | Zendy; Min Chen | Zendy; Soyoung Kim | Zendy; Kwang Woo Ahn | Zendy; Krishna V. Komanduri | Zendy; Caroline A. Lindemans | Zendy; Jeffery J. Auletta | Zendy; Marcie L. Riches | Zendy; Hisham AbdelAzim | Zendy; Ibrahim Ahmed | Zendy; Mahmoud Aljurf | Zendy; Joseph Antin | Zendy; Karen K. Ballen | Zendy; Amer Beitinjaneh | Zendy; Valerie I. Brown | Zendy; Jan Černý | Zendy; Richard Champlin | Zendy; Nelson J. Chao | Zendy; Saurabh Chhabra | Zendy; Parastoo B. Dahi | Zendy; Andrew Daly | Zendy; Christopher E. Dandoy | Zendy; Christopher C. Dvorak | Zendy; Stephen J. Forman | Zendy; Siddhartha Ganguly | Zendy; Shahrukh K. Hashmi | Zendy; Mohamed A. KharfanDabaja | Zendy; Hillard M. Lazarus | Zendy; Per Ljungman | Zendy; Adriana K. Malone | Zendy; Guru Subramanian Guru Murthy | Zendy; Taiga Nishihori | Zendy; Kristin Page | Zendy; Ravi Pingali | Zendy; Vijay Reddy | Zendy; Ayman Saad | Zendy; Bipin N. Savani | Zendy; Matthew D. Seftel | Zendy; Jeff Szer | Zendy; Ravi Vij | Zendy; Daniel J. Weisdorf | Zendy; Basem M. William | Zendy; Kirsten M. Williams | Zendy; Baldeep Wirk | Zendy; Jean A. Yared | Zendy

Open Access

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(s) -

Genovefa A. Papanicolaou,

Celalettin Üstün,

JoAnne H. Young,

Min Chen,

Soyoung Kim,

Kwang Woo Ahn,

Krishna V. Komanduri,

Caroline A. Lindemans,

Jeffery J. Auletta,

Marcie L. Riches,

Hisham AbdelAzim,

Ibrahim Ahmed,

Mahmoud Aljurf,

Joseph Antin,

Karen K. Ballen,

Amer Beitinjaneh,

Valerie I. Brown,

Jan Černý,

Richard Champlin,

Nelson J. Chao,

Saurabh Chhabra,

Parastoo B. Dahi,

Andrew Daly,

Christopher E. Dandoy,

Christopher C. Dvorak,

Stephen J. Forman,

Siddhartha Ganguly,

Shahrukh K. Hashmi,

Mohamed A. KharfanDabaja,

Hillard M. Lazarus,

Per Ljungman,

Adriana K. Malone,

Guru Subramanian Guru Murthy,

Taiga Nishihori,

Kristin Page,

Ravi Pingali,

Vijay Reddy,

Ayman Saad,

Bipin N. Savani,

Matthew D. Seftel,

Jeff Szer,

Ravi Vij,

Daniel J. Weisdorf,

Basem M. William,

Kirsten M. Williams,

Baldeep Wirk,

Jean A. Yared

Publication year - 2019

Publication title -

clinical infectious diseases

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 3.44

H-Index - 336

eISSN - 1537-6591

pISSN - 1058-4838

DOI - 10.1093/cid/ciz031

Subject(s) - medicine , hematopoietic cell , enterococcus , vancomycin resistant enterococcus , retrospective cohort study , hematopoietic stem cell transplantation , transplantation , leukemia , acute leukemia , myelodysplastic syndromes , immunology , bacteremia , vancomycin , haematopoiesis , microbiology and biotechnology , antibiotics , stem cell , bone marrow , bacteria , biology , staphylococcus aureus , genetics

Background We 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. Methods Adult 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. Results Of 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). Conclusions VRE 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.

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