Vancomycin-resistant Enterococcus colonization and bloodstream infection

prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia

Mehrdad Hefazi, Moussab Damlaj, Hassan B. Alkhateeb, Daniel K. Partain, Robin Patel, Raymund R Razonable, Dennis A. Gastineau, Aref Al-Kali, Shahrukh K. Hashmi, William Hogan, Mark R Litzow, Mrinal M Patnaik

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Screening for vancomycin-resistant Enterococcus (VRE) is performed at many transplant centers, but data on the impact of VRE colonization and bloodstream infection (BSI) on hematopoietic cell transplantation (HCT) outcomes remain conflicting. Methods: Consecutive adults with acute myeloid leukemia who underwent allogeneic HCT between 2004 and 2014 were retrospectively reviewed. Patients were screened by perirectal PCR swabs targeting vanA and vanB twice weekly while inpatient. Results: Of a total of 203 patients (median age 54 years), 73 (36%) were VRE colonized prior to HCT, 23 (11%) became colonized within the first 100 days, and 107 (53%) remained non-colonized through day 100 post HCT. A landmark analysis on HCT day 0 revealed no significant difference in overall survival according to pre-transplant colonization status (P=.20). However, patients with subsequent VRE colonization within the first 100 days of HCT had a significantly worse survival on both univariable (P=.04) and multivariable (P=.03) analyses. During the first 30 days post HCT, 11 (5% of total and 11% of the VRE colonized) patients developed VRE BSI. Ten (91%) of these had screened positive for VRE colonization before the bacteremia. Age ≥60 years, HCT-comorbidity index ≥3, and VRE colonization were independent risk factors for VRE BSI on multivariable analysis (P=.04,.03,.003, respectively). Only 1 (9%) patient with VRE BSI died within the first 100 days post HCT. Conclusion: VRE colonization is a surrogate marker and not an independent predictor of worse outcomes post HCT. VRE BSI is associated with increased morbidity, but does not impact post-HCT survival.

Original languageEnglish (US)
Pages (from-to)913-920
Number of pages8
JournalTransplant Infectious Disease
Volume18
Issue number6
DOIs
StatePublished - Dec 1 2016

Fingerprint

Cell Transplantation
Acute Myeloid Leukemia
Infection
Vancomycin-Resistant Enterococci
Transplants
Survival
Bacteremia
Comorbidity
Inpatients
Cell Survival
Biomarkers
Morbidity

Keywords

  • allogeneic hematopoietic cell transplantation
  • bloodstream infection
  • colonization
  • vancomycin-resistant Enterococcus

ASJC Scopus subject areas

  • Transplantation
  • Infectious Diseases

Cite this

Vancomycin-resistant Enterococcus colonization and bloodstream infection : prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia. / Hefazi, Mehrdad; Damlaj, Moussab; Alkhateeb, Hassan B.; Partain, Daniel K.; Patel, Robin; Razonable, Raymund R; Gastineau, Dennis A.; Al-Kali, Aref; Hashmi, Shahrukh K.; Hogan, William; Litzow, Mark R; Patnaik, Mrinal M.

In: Transplant Infectious Disease, Vol. 18, No. 6, 01.12.2016, p. 913-920.

Research output: Contribution to journalArticle

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title = "Vancomycin-resistant Enterococcus colonization and bloodstream infection: prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia",
abstract = "Background: Screening for vancomycin-resistant Enterococcus (VRE) is performed at many transplant centers, but data on the impact of VRE colonization and bloodstream infection (BSI) on hematopoietic cell transplantation (HCT) outcomes remain conflicting. Methods: Consecutive adults with acute myeloid leukemia who underwent allogeneic HCT between 2004 and 2014 were retrospectively reviewed. Patients were screened by perirectal PCR swabs targeting vanA and vanB twice weekly while inpatient. Results: Of a total of 203 patients (median age 54 years), 73 (36{\%}) were VRE colonized prior to HCT, 23 (11{\%}) became colonized within the first 100 days, and 107 (53{\%}) remained non-colonized through day 100 post HCT. A landmark analysis on HCT day 0 revealed no significant difference in overall survival according to pre-transplant colonization status (P=.20). However, patients with subsequent VRE colonization within the first 100 days of HCT had a significantly worse survival on both univariable (P=.04) and multivariable (P=.03) analyses. During the first 30 days post HCT, 11 (5{\%} of total and 11{\%} of the VRE colonized) patients developed VRE BSI. Ten (91{\%}) of these had screened positive for VRE colonization before the bacteremia. Age ≥60 years, HCT-comorbidity index ≥3, and VRE colonization were independent risk factors for VRE BSI on multivariable analysis (P=.04,.03,.003, respectively). Only 1 (9{\%}) patient with VRE BSI died within the first 100 days post HCT. Conclusion: VRE colonization is a surrogate marker and not an independent predictor of worse outcomes post HCT. VRE BSI is associated with increased morbidity, but does not impact post-HCT survival.",
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author = "Mehrdad Hefazi and Moussab Damlaj and Alkhateeb, {Hassan B.} and Partain, {Daniel K.} and Robin Patel and Razonable, {Raymund R} and Gastineau, {Dennis A.} and Aref Al-Kali and Hashmi, {Shahrukh K.} and William Hogan and Litzow, {Mark R} and Patnaik, {Mrinal M}",
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T2 - prevalence, risk factors, and the impact on early outcomes after allogeneic hematopoietic cell transplantation in patients with acute myeloid leukemia

AU - Hefazi, Mehrdad

AU - Damlaj, Moussab

AU - Alkhateeb, Hassan B.

AU - Partain, Daniel K.

AU - Patel, Robin

AU - Razonable, Raymund R

AU - Gastineau, Dennis A.

AU - Al-Kali, Aref

AU - Hashmi, Shahrukh K.

AU - Hogan, William

AU - Litzow, Mark R

AU - Patnaik, Mrinal M

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N2 - Background: Screening for vancomycin-resistant Enterococcus (VRE) is performed at many transplant centers, but data on the impact of VRE colonization and bloodstream infection (BSI) on hematopoietic cell transplantation (HCT) outcomes remain conflicting. Methods: Consecutive adults with acute myeloid leukemia who underwent allogeneic HCT between 2004 and 2014 were retrospectively reviewed. Patients were screened by perirectal PCR swabs targeting vanA and vanB twice weekly while inpatient. Results: Of a total of 203 patients (median age 54 years), 73 (36%) were VRE colonized prior to HCT, 23 (11%) became colonized within the first 100 days, and 107 (53%) remained non-colonized through day 100 post HCT. A landmark analysis on HCT day 0 revealed no significant difference in overall survival according to pre-transplant colonization status (P=.20). However, patients with subsequent VRE colonization within the first 100 days of HCT had a significantly worse survival on both univariable (P=.04) and multivariable (P=.03) analyses. During the first 30 days post HCT, 11 (5% of total and 11% of the VRE colonized) patients developed VRE BSI. Ten (91%) of these had screened positive for VRE colonization before the bacteremia. Age ≥60 years, HCT-comorbidity index ≥3, and VRE colonization were independent risk factors for VRE BSI on multivariable analysis (P=.04,.03,.003, respectively). Only 1 (9%) patient with VRE BSI died within the first 100 days post HCT. Conclusion: VRE colonization is a surrogate marker and not an independent predictor of worse outcomes post HCT. VRE BSI is associated with increased morbidity, but does not impact post-HCT survival.

AB - Background: Screening for vancomycin-resistant Enterococcus (VRE) is performed at many transplant centers, but data on the impact of VRE colonization and bloodstream infection (BSI) on hematopoietic cell transplantation (HCT) outcomes remain conflicting. Methods: Consecutive adults with acute myeloid leukemia who underwent allogeneic HCT between 2004 and 2014 were retrospectively reviewed. Patients were screened by perirectal PCR swabs targeting vanA and vanB twice weekly while inpatient. Results: Of a total of 203 patients (median age 54 years), 73 (36%) were VRE colonized prior to HCT, 23 (11%) became colonized within the first 100 days, and 107 (53%) remained non-colonized through day 100 post HCT. A landmark analysis on HCT day 0 revealed no significant difference in overall survival according to pre-transplant colonization status (P=.20). However, patients with subsequent VRE colonization within the first 100 days of HCT had a significantly worse survival on both univariable (P=.04) and multivariable (P=.03) analyses. During the first 30 days post HCT, 11 (5% of total and 11% of the VRE colonized) patients developed VRE BSI. Ten (91%) of these had screened positive for VRE colonization before the bacteremia. Age ≥60 years, HCT-comorbidity index ≥3, and VRE colonization were independent risk factors for VRE BSI on multivariable analysis (P=.04,.03,.003, respectively). Only 1 (9%) patient with VRE BSI died within the first 100 days post HCT. Conclusion: VRE colonization is a surrogate marker and not an independent predictor of worse outcomes post HCT. VRE BSI is associated with increased morbidity, but does not impact post-HCT survival.

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KW - vancomycin-resistant Enterococcus

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