10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients

MacAllister, Trenton; Stohs, Erica; Liu, Catherine; Bryan, Andrew; Phipps, Amanda I.; Pergam, Steven A.

doi:10.1016/j.jinf.2018.02.014

Cited by 9 publications

(3 citation statements)

References 52 publications

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“…Antibiotic use patterns partially depend on evolving local epidemiological patterns for common multidrug-resistant organisms. The rates of vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus infections in our patients were low during this study . Our Clostridioides difficile infection rates have been approximately 10% in the last several years .…”

Section: Discussionmentioning

confidence: 54%

“…The rates of vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus infections in our patients were low during this study. 33 , 34 Our Clostridioides difficile infection rates have been approximately 10% in the last several years. 35 We see 1 to 3 infections with carbapenem-resistant Enterobacterales per year.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation

et al. 2023

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ImportanceCertain antibiotic exposures have been associated with increased rates of acute graft-vs-host disease (aGVHD) after allogeneic hematopoietic cell transplantation (allo-HCT). Since antibiotic exposure can both affect and be affected by infections, analyzing time-dependent exposure in the presence of multiple potential confounders, including prior antibiotic exposures, poses specific analytical challenges, necessitating both a large sample size and unique approaches.ObjectiveTo identify antibiotics and antibiotic exposure timeframes associated with subsequent aGVHD.Design, Setting, and ParticipantsThis cohort study assessed allo-HCT at a single center from 2010 to 2021. Participants included all patients aged at least 18 years who underwent their first T-replete allo-HCT, with at least 6 months of follow-up. Data were analyzed from August 1 to December 15, 2022.ExposuresAntibiotics between 7 days before and 30 days after transplant.Main Outcomes and MeasuresThe primary outcome was grade II to IV aGVHD. The secondary outcome was grade III to IV aGVHD. Data were analyzed using 3 orthogonal methods: conventional Cox proportional hazard regression, marginal structural models, and machine learning.ResultsA total of 2023 patients (median [range] age, 55 [18-78] years; 1153 [57%] male) were eligible. Weeks 1 and 2 after HCT were the highest-risk intervals, with multiple antibiotic exposures associated with higher rates of subsequent aGVHD. In particular, exposure to carbapenems during weeks 1 and 2 after allo-HCT was consistently associated with increased risk of aGVHD (minimum hazard ratio [HR] among models, 2.75; 95% CI, 1.77-4.28), as was week 1 after allo-HCT exposure to combinations of penicillins with a β-lactamase inhibitor (minimum HR among models, 6.55; 95% CI, 2.35-18.20).Conclusions and RelevanceIn this cohort study of allo-HCT recipients, antibiotic choices and schedules in the early course of transplantation were associated with aGVHD rates. These findings should be considered in antibiotic stewardship programs.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation

et al. 2023

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“…Rectal colonization with VRE has been reported as a risk factor for subsequent BSI in recipients of allogeneic hematopoietic stem cell transplantation [4,28,29]. Notably, 68% of our cohort who were screened for VRE prior to BSI were positive, highlighting the potential benefits of screening to guide empiric therapy.…”

Section: Discussionmentioning

confidence: 75%

Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting

et al. 2020

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Background: Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients. Methods: A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008-2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission. Results: Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days. Conclusions: VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.

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Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers

Kaya¹,

Kaya

Balkan

et al. 2020

Wien Klin Wochenschr

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10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients

Cited by 9 publications

References 52 publications

Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation

Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation

Epidemiology, treatment and outcomes of bloodstream infection due to vancomycin-resistant enterococci in cancer patients in a vanB endemic setting

Risk factors for development of vancomycin-resistant enterococcal bacteremia among VRE colonizers

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