288. Risk Factors Associated with Faster Time to VRE Positivity in Acute Myeloid Leukemia Patients Undergoing Initial Intensive Induction Chemotherapy with Cytarabine and Idarubicin
Session: Poster Abstract Session: HAI: MSSA, MRSA, and other Gram-Positives
Thursday, October 27, 2016
Room: Poster Hall
  • IDSA RH FINAL.pdf (517.9 kB)
  • Background: Patients with acute myeloid leukemia (AML) are at increased risk of colonization and infection with vancomycin-resistant Enterococci (VRE). Infectious Diseases Society of America (IDSA) guidelines recommend judicious use of vancomycin in patients with febrile neutropenia to curb the development of bacterial resistance. This study was conducted to identify risk factors associated with faster time to VRE positivity in this patient population.

    Methods: This was a retrospective electronic chart review of patients admitted between 1 January 2012 and 31 December 2015 who received initial intensive induction chemotherapy with cytarabine plus idarubicin. Patients were included if they had at least two VRE rectal swabs or cultures taken during their admission, with the first one being negative. The primary objective of this study was to evaluate potential risk factors associated with faster time to VRE positivity. Several variables were treated as time-varying covariates in order to produce a more accurate understanding of the hazard associated with these predictors. The secondary objective was to assess the impact of VRE rectal swab positivity on subsequent VRE infection.

    Results: Two hundred twenty-nine patients were included. Vancomycin was utilized in 92% (210/229) of patients. Overall 59% (134/229) of patients developed VRE positivity; 71% (95/134) detected by rectal swab only, 22% (29/134) by both rectal swab and non-rectal swab culture, and the remaining 7% (10/134) by non-rectal swab culture only. Variables associated with faster time to VRE positivity on multivariable analysis were heme positive stool sample [HR 3.537 (95% CI 1.644-7.608), p=0.001], cephalosporin utilization [HR 1.596 (95% CI 1.126-2.262), p=0.009], and intravenous vancomycin utilization [HR 1.548 (95% CI 1.060-2.259), p=0.024]. VRE infection developed in 20% (25/126) of patients who were VRE positive prior to infection, contrasted with only 8% (8/103) of patients who were VRE negative prior to infection (p=0.01).

    Conclusion: Judicious prescribing of intravenous vancomycin as outlined in IDSA guidelines should be practiced in an effort to reduce the development of VRE.

    Ronald Heisel, PharmD1, Robert Sutton, PharmD2, Gerard Mascara, PharmD1, Daniel Winger, MS3, Seah Lim, MD1, David Weber, MD1 and Louise-Marie Oleksiuk, PharmD1, (1)UPMC Presbyterian Shadyside, Pittsburgh, PA, (2)University of Pittsburgh School of Pharmacy, Pittsburgh, PA, (3)University of Pittsburgh, Clinical and Translational Science Institute, Pittsburgh, PA


    R. Heisel, None

    R. Sutton, None

    G. Mascara, None

    D. Winger, None

    S. Lim, None

    D. Weber, None

    L. M. Oleksiuk, Theravance Biopharma: Consultant , Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.