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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.

Publication ,  Journal Article
Papanicolaou, GA; Ustun, C; Young, J-AH; Chen, M; Kim, S; Woo Ahn, K; Komanduri, K; Lindemans, C; Auletta, JJ; Riches, ML ...
Published in: Clin Infect Dis
October 30, 2019

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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Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

October 30, 2019

Volume

69

Issue

10

Start / End Page

1771 / 1779

Location

United States

Related Subject Headings

  • Young Adult
  • Vancomycin-Resistant Enterococci
  • Vancomycin
  • Transplantation Conditioning
  • Retrospective Studies
  • Myelodysplastic Syndromes
  • Middle Aged
  • Microbiology
  • Leukemia, Myeloid, Acute
  • Infant
 

Citation

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Papanicolaou, G. A., Ustun, C., Young, J.-A., Chen, M., Kim, S., Woo Ahn, K., … CIBMTR® Infection and Immune Reconstitution Working Committee. (2019). 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. Clin Infect Dis, 69(10), 1771–1779. https://doi.org/10.1093/cid/ciz031
Papanicolaou, Genovefa A., Celalettin Ustun, Jo-Anne H. Young, Min Chen, Soyoung Kim, Kwang Woo Ahn, Krishna Komanduri, et al. “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.Clin Infect Dis 69, no. 10 (October 30, 2019): 1771–79. https://doi.org/10.1093/cid/ciz031.
Papanicolaou GA, Ustun C, Young J-AH, Chen M, Kim S, Woo Ahn K, Komanduri K, Lindemans C, Auletta JJ, Riches ML, CIBMTR® Infection and Immune Reconstitution Working Committee. 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. Clin Infect Dis. 2019 Oct 30;69(10):1771–1779.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

October 30, 2019

Volume

69

Issue

10

Start / End Page

1771 / 1779

Location

United States

Related Subject Headings

  • Young Adult
  • Vancomycin-Resistant Enterococci
  • Vancomycin
  • Transplantation Conditioning
  • Retrospective Studies
  • Myelodysplastic Syndromes
  • Middle Aged
  • Microbiology
  • Leukemia, Myeloid, Acute
  • Infant