TY - JOUR
T1 - Bloodstream Infection Due to Vancomycin-resistant Enterococcus Is Associated with Increased Mortality after Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome
T2 - A Multicenter, Retrospective Cohort Study
AU - Papanicolaou, Genovefa A.
AU - Ustun, Celalettin
AU - Young, Jo Anne H.
AU - Chen, Min
AU - Kim, Soyoung
AU - Woo Ahn, Kwang
AU - Komanduri, Krishna
AU - Lindemans, Caroline
AU - Auletta, Jeffery J.
AU - Riches, Marcie L.
AU - Abdel-Azim, Hisham
AU - Ahmed, Ibrahim A.
AU - Aljurf, Mahmoud
AU - Antin, Joseph
AU - Ballen, Karen Kuhn
AU - Beitinjaneh, Amer
AU - Brown, Valerie I.
AU - Cerny, Jan
AU - Champlin, Richard
AU - Chao, Nelson
AU - Chhabra, Saurabh
AU - Dahi, Parastoo B.
AU - Daly, Andrew
AU - Dandoy, Christopher
AU - Dvorak, Christopher C.
AU - Forman, Stephen
AU - Ganguly, Siddhartha
AU - Hashmi, Shahrukh K.
AU - Kharfan-Dabaja, Mohamed A.
AU - Lazarus, Hillard
AU - Ljungman, Per
AU - Malone, Adriana K.
AU - Murthy, Guru
AU - Nishihori, Taiga
AU - Page, Kristin
AU - Pingali, Ravi Sai Ravi
AU - Reddy, Vijay
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Seftel, Matthew
AU - Szer, Jeffrey
AU - Vij, Ravi
AU - Weisdorf, Daniel
AU - William, Basem M.
AU - Williams, Kirsten
AU - Wirk, Baldeep
AU - Yared, Jean
N1 - Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2019/11/15
Y1 - 2019/11/15
N2 - 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.
AB - 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.
KW - bacteremia
KW - hematopoietic stem cell transplantation
KW - mortality
KW - vancomycin-resistant Enterococcus (VRE)
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U2 - 10.1093/cid/ciz031
DO - 10.1093/cid/ciz031
M3 - Article
C2 - 30649224
AN - SCOPUS:85066129430
SN - 1058-4838
VL - 69
SP - 1771
EP - 1779
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -