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.
Adolescent
Adult
Aged
Anti-Bacterial Agents
/ pharmacology
Bacteremia
/ microbiology
Child
Child, Preschool
Gram-Positive Bacterial Infections
/ mortality
Hematopoietic Stem Cell Transplantation
/ adverse effects
Humans
Infant
Leukemia, Myeloid, Acute
/ mortality
Middle Aged
Myelodysplastic Syndromes
/ mortality
Retrospective Studies
Transplantation Conditioning
Vancomycin
/ pharmacology
Vancomycin-Resistant Enterococci
/ pathogenicity
Young Adult
bacteremia
hematopoietic stem cell transplantation
mortality
vancomycin-resistant Enterococcus (VRE)
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
30 10 2019
30 10 2019
Historique:
received:
01
08
2018
accepted:
10
01
2019
pubmed:
17
1
2019
medline:
26
9
2020
entrez:
17
1
2019
Statut:
ppublish
Résumé
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. 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. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 30649224
pii: 5289185
doi: 10.1093/cid/ciz031
pmc: PMC6821199
doi:
Substances chimiques
Anti-Bacterial Agents
0
Vancomycin
6Q205EH1VU
Types de publication
Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1771-1779Subventions
Organisme : NCI NIH HHS
ID : P30 CA008748
Pays : United States
Organisme : NCI NIH HHS
ID : P01 CA023766
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA076518
Pays : United States
Organisme : NHLBI NIH HHS
ID : U24 HL138660
Pays : United States
Investigateurs
Hisham Abdel-Azim
(H)
Ibrahim A Ahmed
(IA)
Mahmoud Aljurf
(M)
Joseph Antin
(J)
Karen Kuhn Ballen
(KK)
Amer Beitinjaneh
(A)
Valerie I Brown
(VI)
Jan Cerny
(J)
Richard Champlin
(R)
Nelson Chao
(N)
Saurabh Chhabra
(S)
Parastoo B Dahi
(PB)
Andrew Daly
(A)
Christopher Dandoy
(C)
Christopher C Dvorak
(CC)
Stephen Forman
(S)
Siddhartha Ganguly
(S)
Shahrukh K Hashmi
(SK)
Mohamed A Kharfan-Dabaja
(MA)
Hillard Lazarus
(H)
Per Ljungman
(P)
Adriana K Malone
(AK)
Guru Murthy
(G)
Taiga Nishihori
(T)
Kristin Page
(K)
Ravi Sai Ravi Pingali
(RSR)
Vijay Reddy
(V)
Ayman Saad
(A)
Bipin N Savani
(BN)
Matthew Seftel
(M)
Jeffrey Szer
(J)
Ravi Vij
(R)
Daniel Weisdorf
(D)
Basem M William
(BM)
Kirsten Williams
(K)
Baldeep Wirk
(B)
Jean Yared
(J)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
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