We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
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.
- Authors
Papanicolaou, Genovefa A; Ustun, Celalettin; Young, Jo-Anne H; Chen, Min; Kim, Soyoung; Ahn, Kwang Woo; Komanduri, Krishna; Lindemans, Caroline; Auletta, Jeffery J; Riches, Marcie L; Committee, CIBMTR® Infection and Immune Reconstitution Working
- Abstract
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.
- Subjects
CORD blood transplantation; MORTALITY risk factors; AGE distribution; BACTEREMIA; CONFIDENCE intervals; CYTOMEGALOVIRUS diseases; ENTEROCOCCUS; HEMATOPOIETIC stem cell transplantation; HOMOGRAFTS; LEUKEMIA; LONGITUDINAL method; MULTIVARIATE analysis; MYELODYSPLASTIC syndromes; PEDIATRICS; RISK assessment; SURVIVAL analysis (Biometry); TUMOR classification; ENTEROCOCCAL infections; VANCOMYCIN resistance; COMORBIDITY; RELATIVE medical risk; TREATMENT effectiveness; RETROSPECTIVE studies; ACUTE diseases; DISEASE complications
- Publication
Clinical Infectious Diseases, 2019, Vol 69, Issue 10, p1771
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciz031