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

Genovefa A. Papanicolaou, Celalettin Ustun, Jo Anne H. Young, Min Chen, Soyoung Kim, Kwang Woo Ahn, Krishna Komanduri, Caroline Lindemans, Jeffery J. Auletta, Marcie L. Riches, Hisham Abdel-Azim, Ibrahim A. Ahmed, Mahmoud Aljurf, Joseph Antin, Karen Kuhn Ballen, Amer Beitinjaneh, Valerie I. Brown, Jan Cerny, Richard Champlin, Nelson ChaoSaurabh Chhabra, Parastoo B. Dahi, Andrew Daly, Christopher Dandoy, Christopher C. Dvorak, Stephen Forman, Siddhartha Ganguly, Shahrukh K. Hashmi, Mohamed A. Kharfan-Dabaja, Hillard Lazarus, Per Ljungman, Adriana K. Malone, Guru Murthy, Taiga Nishihori, Kristin Page, Ravi Sai Ravi Pingali, Vijay Reddy, Ayman Saad, Bipin N. Savani, Matthew Seftel, Jeffrey Szer, Ravi Vij, Daniel Weisdorf, Basem M. William, Kirsten Williams, Baldeep Wirk, Jean Yared

Research output: Contribution to journalArticle

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1771-1779
Number of pages9
JournalClinical Infectious Diseases
Volume69
Issue number10
DOIs
StatePublished - Nov 15 2019

Keywords

  • bacteremia
  • hematopoietic stem cell transplantation
  • mortality
  • vancomycin-resistant Enterococcus (VRE)

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    Papanicolaou, G. A., Ustun, C., Young, J. A. H., Chen, M., Kim, S., Woo Ahn, K., Komanduri, K., Lindemans, C., Auletta, J. J., Riches, M. L., Abdel-Azim, H., Ahmed, I. A., Aljurf, M., Antin, J., Ballen, K. K., Beitinjaneh, A., Brown, V. I., Cerny, J., Champlin, R., ... Yared, J. (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. Clinical Infectious Diseases, 69(10), 1771-1779. https://doi.org/10.1093/cid/ciz031