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- Title
Changing Epidemiology of Bloodstream Infection Due to Enterococcus for Patients with Acute Leukemia: A Retrospective Cohort Study.
- Authors
Raeseok Lee; Dong-Gun Lee; Sung-Yeon Cho; Tae-hoon No
- Abstract
배경 Prolonged use of antibiotics and mucosal injury by intensive chemotherapy are important risk factors for Enterococcal infection in patients with acute leukemia. This study aimed to identify the changes in the epidemiology of Enterococcal bloodstream infection (BSI) and to investigate the impact of Enterococcal BSI on long-term outcome in patients with acute leukemia. 방법 All adult acute leukemia patients diagnosed with Enterococcal BSI (N = 512) between 2014 to 2018 at the Catholic Hematology Hospital were retrospectively reviewed. During the study period, the new institutional strategy of restricting fluoroquinolone prophylaxis and saving carbapenem applied since OCT 2016. The incidence rate was assessed with antibiotics consumption and multivariable models were used to estimate the impact of vancomycin-resistant Enterococcal BSI on the outcome. 결과 During the study period, 512 Enterococcal BSI cases were identified in 433 patients: 172 (33.6%) were vancomycin-resistant Enterococcus (VRE). There was no difference in baseline characteristics between VRE and vancomycin-susceptible Enterococcus BSI. The incidence rate of VRE decreased for 6 months after the strategy change (39.2% vs 12.2%, Odds ratio [OR]=0.312, 95% confidence interval [CI], 0.116-0.843, p=0.018). However, the incidence rate showed increasing trend with the increased use of total antibiotics consumption. VRE BSI was associated with higher 100-day mortality than VSE BSI after adjusting for covariates (hazard ratio [HR]=1.477; 95% CI, 1.027-2.125, p=0.035), but there was no difference in long-term outcome at one year. In multivariable models, high-risk groups such as 60 years or older, advanced stage of disease, polymicrobial BSI, high Pitt bacteremia score, and BSI complications in hematopoietic cell transplantation recipient were strongly associated with worse overall mortality at one year (p<0.05 for all variables). 결론 The incidence of Enterococcal BSI is closely related to the total antibiotics consumption and it has a worse impact on the long-term outcome in high-risk groups. Restricting the use of prophylactic fluoroquinolone and carbapenem alone is not sufficient to reduce total antibiotics consumption but also Enterococcal BSI. Multidisciplinary interventions to reduce the overall use of antibiotics are needed.
- Subjects
ACUTE leukemia; EPIDEMIOLOGY; COHORT analysis; CELL transplantation; ENTEROCOCCAL infections; ODDS ratio
- Publication
Infection & Chemotherapy, 2020, Vol 52, pS328
- ISSN
2093-2340
- Publication type
Article