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Vancomycin‐resistant E nterococcus colonization and bloodstream infection: prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia
Author(s) -
Hefazi Mehrdad,
Damlaj Moussab,
Alkhateeb Hassan B.,
Partain Daniel K.,
Patel Robin,
Razonable Raymund R.,
Gastineau Dennis A.,
AlKali Aref,
Hashmi Shahrukh K.,
Hogan William J.,
Litzow Mark R.,
Patnaik Mrinal M.
Publication year - 2016
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12612
Subject(s) - medicine , vancomycin resistant enterococcus , bacteremia , colonization , transplantation , enterococcus , bloodstream infection , hematopoietic stem cell transplantation , hematopoietic cell , myeloid leukemia , vancomycin , antibiotics , haematopoiesis , stem cell , microbiology and biotechnology , staphylococcus aureus , biology , bacteria , genetics
Background Screening for vancomycin‐resistant Enterococcus ( VRE ) is performed at many transplant centers, but data on the impact of VRE colonization and bloodstream infection ( BSI ) on hematopoietic cell transplantation ( HCT ) outcomes remain conflicting. Methods Consecutive adults with acute myeloid leukemia who underwent allogeneic HCT between 2004 and 2014 were retrospectively reviewed. Patients were screened by perirectal PCR swabs targeting vanA and vanB twice weekly while inpatient. Results Of a total of 203 patients (median age 54 years), 73 (36%) were VRE colonized prior to HCT , 23 (11%) became colonized within the first 100 days, and 107 (53%) remained non‐colonized through day 100 post HCT . A landmark analysis on HCT day 0 revealed no significant difference in overall survival according to pre‐transplant colonization status ( P =.20). However, patients with subsequent VRE colonization within the first 100 days of HCT had a significantly worse survival on both univariable ( P =.04) and multivariable ( P =.03) analyses. During the first 30 days post HCT , 11 (5% of total and 11% of the VRE colonized) patients developed VRE BSI . Ten (91%) of these had screened positive for VRE colonization before the bacteremia. Age ≥60 years, HCT ‐comorbidity index ≥3, and VRE colonization were independent risk factors for VRE BSI on multivariable analysis ( P =.04, .03, .003, respectively). Only 1 (9%) patient with VRE BSI died within the first 100 days post HCT . Conclusion VRE colonization is a surrogate marker and not an independent predictor of worse outcomes post HCT . VRE BSI is associated with increased morbidity, but does not impact post‐ HCT survival.