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Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population.

Publication ,  Journal Article
Messina, JA; Tan, CY; Ren, Y; Hill, L; Bush, A; Lew, M; Andermann, T; Peled, JU; Gomes, A; van den Brink, MRM; Chao, NJ; Surana, NK; Sung, AD
Published in: Clin Infect Dis
December 20, 2021

BACKGROUND: Enterococcus intestinal domination (EID), a state of dysbiosis wherein enterococci comprise ≥30% abundance within the microbiota, has been associated with Enterococcus bacteremia, graft-versus-host disease, and mortality in the allogeneic hematopoietic stem cell transplant (allo HCT) population. The acute leukemia (AL) chemotherapy population includes patients receiving intensive chemotherapy but do not all go on to have an allo HCT. The impact of EID on outcomes including mortality in the AL chemotherapy population is unknown. METHODS: Microbiota composition from weekly stool samples was analyzed by 16S ribosomal RNA gene sequencing. Patients were analyzed in 2 cohorts: AL chemotherapy cohort and allo HCT cohort. Alpha-diversity and richness were calculated. Kaplan Meier Analysis was used to analyze mortality. RESULTS: 929 stool samples were collected from 139 patients. Both allo HCT and AL cohorts had a decline in α-diversity and richness over the course of treatment that tends not to return to baseline months later. EID was observed in at least one sample in 36% of allo HCT patients and 49% of AL patients. Patients with observed EID had lower alpha-diversity over time. Similar to the HCT cohort, AL patients with EID had reduced overall survival. We identified 4 other genera that were commonly found in ≥30% relative abundance within the microbiota, but none were associated with mortality. In fact, in allo HCT, Bacteroides abundance ≥30% was associated with improved survival. CONCLUSIONS: EID is associated with increased all-cause mortality in HCT and AL cohorts. UnlikeEID, relative abundance ≥30% by other genera is not associated with increased all-cause mortality.

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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 20, 2021

Volume

78

Issue

2

Start / End Page

414 / 422

Location

United States

Related Subject Headings

  • Microbiology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences
 

Citation

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Chicago
ICMJE
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Messina, J. A., Tan, C. Y., Ren, Y., Hill, L., Bush, A., Lew, M., … Sung, A. D. (2021). Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population. Clin Infect Dis, 78(2), 414–422. https://doi.org/10.1093/cid/ciab1043
Messina, Julia A., Chin Yee Tan, Yi Ren, Lauren Hill, Amy Bush, Meagan Lew, Tessa Andermann, et al. “Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population.Clin Infect Dis 78, no. 2 (December 20, 2021): 414–22. https://doi.org/10.1093/cid/ciab1043.
Messina JA, Tan CY, Ren Y, Hill L, Bush A, Lew M, et al. Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population. Clin Infect Dis. 2021 Dec 20;78(2):414–22.
Messina, Julia A., et al. “Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population.Clin Infect Dis, vol. 78, no. 2, Dec. 2021, pp. 414–22. Pubmed, doi:10.1093/cid/ciab1043.
Messina JA, Tan CY, Ren Y, Hill L, Bush A, Lew M, Andermann T, Peled JU, Gomes A, van den Brink MRM, Chao NJ, Surana NK, Sung AD. Enterococcus Intestinal Domination is Associated with Increased Mortality in the Acute Leukemia Chemotherapy Population. Clin Infect Dis. 2021 Dec 20;78(2):414–422.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

December 20, 2021

Volume

78

Issue

2

Start / End Page

414 / 422

Location

United States

Related Subject Headings

  • Microbiology
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
  • 06 Biological Sciences