Vancomycin-resistant Enterococcus bloodstream infection (VRE-BSI) may be associated with decreased patient survival after allogeneic hematopoietic stem cell transplantation (HSCT) for acute leukemia and myelodysplastic syndrome, according to a study published in Clinical Infectious Diseases.

The multicenter retrospective cohort study used the Center for International Blood and Marrow Transplant Research database to study the effects of VRE-BSI on adult and pediatric patient outcomes, overall survival (OS), and nonrelapse mortality (NRM) at 1 year after HSCT.

From 2008 to 2012, 7128 patients received first allogeneic HSCT for acute leukemia or myelodysplastic syndrome. Patients were categorized according to BSI status 100 days after HSCT: VRE-BSI (258, 3.6%), non-VRE-BSI (2398, 33.6%), and without BSI (4472, 62.7%). The median time to VRE-BSI and non-VRE-BSI were 11 (range, <1-99) and 15 (range, <1-111) days, respectively.

VRE-BSI was higher in recipients of umbilical cord blood allografts (5.6%) compared with both bone marrow (4.2%) and peripheral blood stem cell recipients (2.5%). In a multivariate model, VRE-BSI was associated with the lowest OS (26%, 99% confidence interval [CI]: 20%-31%) compared with patients with non-VRE-BSI (56%, 99% CI: 54%-58%) or without BSI (66%, 99% CI: 65%-67%; <.0001). Patients with VRE-BSI had a 2.7 times greater risk of 1-year NRM (51%, 99% CI: 44%-57%) compared with patients with non-VRE-BSI (24%, 99% CI: 22%-26%) and a 4.7 times greater risk compared with patients without BSI (15%, 99% CI: 14%-16%; <.0001).

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The authors concluded that this study “[provided] a strong impetus for well-designed interventional studies to modify factors contributing to this life-threatening complication and potentially improve survival.”

Reference

1. Papanicolaou GA, Ustun C, Young J-AH, et al. Bloodstream infection (BSI) due to Vancomycin-Resistant Enterococcus (VRE) is associated with increased mortality after hematopoietic cell transplantation for acute leukemia and myelodysplastic syndrome: A multicenter, retrospective cohort study [published online January 14, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz031