title: Risk factors for vancomycin-resistant enterococcus bacteremia and its influence on survival after allogeneic hematopoietic cell transplantation.
abstract: Vancomycin-resistant enterococcus (VRE) is a well-known infectious complication among immunocompromised patients. We performed a retrospective analysis to identify risk factors for the development of VRE bacteremia (VRE-B) within 15 months after allogeneic hematopoietic cell transplantation (alloHCT) and to determine its prognostic importance for other post-transplant outcomes. Eight hundred consecutive adult patients who underwent alloHCT for hematologic diseases from 1997 to 2011 were included. Seventy-six (10%) developed VRE-B at a median of 46 days post transplant. Year of transplant, higher HCT comorbidity score, a diagnosis of ALL, unrelated donor and umbilical cord blood donor were all significant risk factors on multivariable analysis for the development of VRE-B. Sixty-seven (88%) died within a median of 1.1 months after VRE-B, but only four (6%) of these deaths were attributable to VRE. VRE-B was significantly associated with worse OS (hazard ratio 4.28, 95% confidence interval 3.23-5.66, P<0.001) in multivariable analysis. We conclude that the incidence of VRE-B after alloHCT has increased over time and is highly associated with mortality, although not usually attributable to VRE infection. Rather than being the cause, this may be a marker for a complicated post-transplant course. Strategies to further enhance immune reconstitution post transplant and strict adherence to infection prevention measures are warranted.
authors.affiliation: Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Tavadze
authors.affiliation: Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
authors.affiliation: Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mossad
authors.affiliation: Division of Infectious Diseases (Transplant/Oncology), John Hopkins, Baltimore, MD, USA.
authors.forename: R
authors.initials: R
authors.lastname: Avery
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Yurch
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Pohlman
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: H
authors.initials: H
authors.lastname: Duong
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Dean
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Hill
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Andresen
authors.affiliation: Department of Pediatric Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hanna
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: N
authors.initials: N
authors.lastname: Majhail
authors.affiliation: Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA.
authors.forename: E
authors.initials: E
authors.lastname: Copelan
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: B
authors.initials: B
authors.lastname: Bolwell
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kalaycio
authors.affiliation: Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sobecks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D016983:Enterococcus; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects*; D055815:Young Adult
references.citation: Bone Marrow Transplant. 2005 Mar;35(5):497-9
references.pmid: 15640812
references.citation: Infect Control Hosp Epidemiol. 2007 Sep;28(9):1054-9
references.pmid: 17932826
references.citation: J Infect. 2007 Jun;54(6):567-71
references.pmid: 17188750
references.citation: Clin Infect Dis. 2005 Aug 1;41(3):327-33
references.pmid: 16007529
references.citation: Transpl Infect Dis. 2013 Oct;15(5):466-73
references.pmid: 23911080
references.citation: Biol Blood Marrow Transplant. 2013 May;19(5):720-4
references.pmid: 23380342
references.citation: Biol Blood Marrow Transplant. 2010 Nov;16(11):1576-81
references.pmid: 20685257
references.citation: Clin Infect Dis. 2012 Sep;55(6):764-70
references.pmid: 22693346
references.citation: Infect Control Hosp Epidemiol. 2011 Nov;32(11):1079-85
references.pmid: 22011534
references.citation: Diagn Microbiol Infect Dis. 2000 Mar;36(3):145-58
references.pmid: 10729656
references.citation: Blood. 2012 Jul 5;120(1):6-7
references.pmid: 22767576
references.citation: Epidemiol Infect. 2011 Sep;139(9):1342-50
references.pmid: 21073764
references.citation: Bone Marrow Transplant. 2008 Apr;41(8):709-14
references.pmid: 18195688
references.citation: Biol Blood Marrow Transplant. 2007 May;13(5):615-21
references.pmid: 17448922
references.citation: Blood. 2001 Mar 1;97(5):1196-201
references.pmid: 11222360
references.citation: Blood. 2012 Jul 5;120(1):223-31
references.pmid: 22535662
references.citation: Bone Marrow Transplant. 1995 Jun;15(6):825-8
references.pmid: 7581076
references.citation: J Infect Dis. 2005 Feb 15;191(4):588-95
references.pmid: 15655783
references.citation: Ann Intern Med. 1995 Aug 15;123(4):250-9
references.pmid: 7611590
references.citation: Blood. 2005 Oct 15;106(8):2912-9
references.pmid: 15994282
references.citation: J Korean Med Sci. 2005 Apr;20(2):169-76
references.pmid: 15831982
references.citation: Bone Marrow Transplant. 2008 Feb;41(4):385-92
references.pmid: 18084341
references.citation: Infect Control Hosp Epidemiol. 1999 Oct;20(10):660-3
references.pmid: 10530642
references.citation: Transpl Infect Dis. 2013 Apr;15(2):142-9
references.pmid: 23279656
references.citation: MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):243-8
references.pmid: 21368740
references.citation: Ann Intern Med. 2001 Oct 2;135(7):484-92
references.pmid: 11578151
references.citation: Infect Control Hosp Epidemiol. 2008 May;29(5):404-9
references.pmid: 18419361
references.citation: Support Care Cancer. 2011 Dec;19(12):1969-74
references.pmid: 21110047
references.citation: Transpl Infect Dis. 2013 Jun;15(3):251-8
references.pmid: 23465046