title: Prediction of Bloodstream Infection Due to Vancomycin-Resistant Enterococcus in Patients Undergoing Leukemia Induction or Hematopoietic Stem-Cell Transplantation.
abstract: Bloodstream infection (BSI) to due vancomycin-resistant Enterococcus (VRE) is an important complication of hematologic malignancy. Determining when to use empiric anti-VRE antibiotic therapy in this population remains a clinical challenge.
  A single-center cohort representing 664 admissions for induction or hematopoietic stem-cell transplant (HSCT) from 2006 to 2014 was selected. We derived a prediction score using risk factors for VRE BSI and evaluated the model's predictive performance by calculating it for each of 16232 BSI at-risk inpatient days.
  VRE BSI incidence was 6.5% of admissions (2.7 VRE BSI per 1000 BSI at-risk days). Adjusted 1-year mortality and length of stay were significantly higher in patients with VRE BSI. VRE colonization (adjusted odds ratio [aOR] = 8.4; 95% confidence interval [CI] = 3.4-20.6; P < .0001), renal insufficiency (aOR = 2.4; 95% CI = 1.0-5.8; P = .046), aminoglycoside use (aOR = 4.7; 95% CI = 2.2-9.8; P < .0001), and antianaerobic antibiotic use (aOR = 2.8; 95% CI = 1.3-5.8; P = .007) correlated most closely with VRE BSI. A prediction model with optimal performance included these factors plus gastrointestinal disturbance, severe neutropenia, and prior beta-lactam antibiotic use. The score effectively risk-stratified patients (area under the receiver operating curve = 0.84; 95% CI = 0.79-0.89). At a threshold of ≥5 points, per day probability of VRE BSI was increased nearly 4-fold.
  This novel predictive score is based on risk factors reflecting a plausible pathophysiological model for VRE BSI in patients with hematological malignancy. Integrating VRE colonization status with risk factors for developing BSI is a promising method of guiding rational use of empiric anti-VRE antimicrobial therapy in patients with hematological malignancy. Validation of this novel predictive score is needed to confirm clinical utility.
authors.affiliation: Division of Infectious Disease and.
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Webb
authors.affiliation: LDS Hospital Acute Leukemia, Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Regan
authors.initials: R
authors.lastname: Healy
authors.affiliation: LDS Hospital Acute Leukemia, Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Jacob
authors.initials: J
authors.lastname: Majers
authors.affiliation: Division of Infectious Disease and.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Burr
authors.affiliation: Division of Infectious Disease and.
authors.forename: Michaela
authors.initials: M
authors.lastname: Gazdik
authors.affiliation: Division of Infectious Disease and.
authors.forename: Bert
authors.initials: B
authors.lastname: Lopansri
authors.affiliation: LDS Hospital Acute Leukemia, Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Daanish
authors.initials: D
authors.lastname: Hoda
authors.affiliation: LDS Hospital Acute Leukemia, Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Finn Bo
authors.initials: FB
authors.lastname: Petersen
authors.affiliation: LDS Hospital Acute Leukemia, Blood and Marrow Transplant Program, Intermountain Healthcare, Salt Lake City, Utah.
authors.forename: Clyde
authors.initials: C
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000073602:Antimicrobial Stewardship; D016470:Bacteremia / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014640:Vancomycin / Q000494:pharmacology / Q000627:therapeutic use; D065507:Vancomycin-Resistant Enterococci / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin
keywords: VRE; antibiotic resistance.; antimicrobial stewardship; hematopoietic stem cell transplant; vancomycin-resistant enterococcus