title: Vancomycin-resistant enterococci in acute myeloid leukemia and myelodysplastic syndrome patients undergoing induction chemotherapy with idarubicin and cytarabine.
abstract: We conducted a retrospective study to determine the risk factors associated with vancomycin-resistant enterococci (VRE) acquisition/infection in newly diagnosed acute myeloid leukemia and myelodysplastic syndrome patients undergoing chemotherapy with the 7 + 3 regimen of cytarabine and idarubicin. Although only 2.5% (6/235) patients were colonized with VRE on admission, 59% (134/229) of patients acquired VRE during their hospitalization. Multivariable analysis identified the use of intravenous vancomycin (p = .024; HR: 1.548) and cephalosporin (p = .009; HR: 1.596) as the risk factors for VRE acquisition. VRE infection developed in 14% (33/229) of patients, with bloodstream infections accounting for 82% (27/33) of cases. VRE infection occurred in 25/126 (20%) of the VRE-colonized patients, but only 8/103 (8%) of those who were not (p = .01). Our study provides the evidence for the role of intravenous cephalosporin and vancomycin in VRE acquisition and highlights the clinical significance of VRE colonization in these patients.
authors.affiliation: a Department of Pharmacy , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Heisel
authors.affiliation: b University of Pittsburgh School of Pharmacy , Pittsburgh , PA , USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Sutton
authors.affiliation: a Department of Pharmacy , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Mascara
authors.affiliation: c Clinical and Translational Science Institute, University of Pittsburgh , Pittsburgh , PA , USA.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Winger
authors.affiliation: d Division of Infectious Diseases , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Weber
authors.affiliation: e Division of Hematology/Oncology , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Seah H
authors.initials: SH
authors.lastname: Lim
authors.affiliation: a Department of Pharmacy , University of Pittsburgh Medical Center , Pittsburgh , PA , USA.
authors.forename: Louise-Marie
authors.initials: LM
authors.lastname: Oleksiuk
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D060828:Induction Chemotherapy; D007951:Leukemia, Myeloid / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D003561:Cytarabine; D014640:Vancomycin; D015255:Idarubicin
keywords: Risk factors; VRE; acute myeloid leukemia