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Infections

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

Bone Marrow Transplantation volume 49, pages 1310–1316 (2014)Cite this article

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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.

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Authors and Affiliations

  1. Internal Medicine, Cleveland Clinic, Cleveland, OH, USA

    M Tavadze

  2. Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA

    L Rybicki

  3. Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA

    S Mossad

  4. Division of Infectious Diseases (Transplant/Oncology), John Hopkins, Baltimore, MD, USA

    R Avery

  5. Hematologic Oncology and Blood Disorders, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA

    M Yurch, B Pohlman, H Duong, R Dean, B Hill, S Andresen, N Majhail, B Bolwell, M Kalaycio & R Sobecks

  6. Department of Pediatric Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA

    R Hanna

  7. Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC, USA

    E Copelan

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  1. M Tavadze
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  2. L Rybicki
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  10. S Andresen
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Corresponding author

Correspondence to R Sobecks.

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Tavadze, M., Rybicki, L., Mossad, S. et al. Risk factors for vancomycin-resistant enterococcus bacteremia and its influence on survival after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 49, 1310–1316 (2014). https://doi.org/10.1038/bmt.2014.150

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  • DOI: https://doi.org/10.1038/bmt.2014.150

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