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Bone Marrow Transplant. 2014 Oct;49(10):1310-6. doi: 10.1038/bmt.2014.150. Epub 2014 Aug 11.

Risk factors for vancomycin-resistant enterococcus bacteremia and its influence on survival after allogeneic hematopoietic cell transplantation.

Author information

1
Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
2
Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA.
3
Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
4
Division of Infectious Diseases (Transplant/Oncology), John Hopkins, Baltimore, MD, USA.
5
Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
6
Department of Pediatric Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA.
7
Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA.

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.

PMID:
25111516
DOI:
10.1038/bmt.2014.150
[Indexed for MEDLINE]

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