793. Risk Factors and Outcomes of Vancomycin-Resistant vs. Vancomycin-Sensitive Enterococcal Blood Stream Infections in Patients with Acute Myeloid Leukemia
Session: Poster Abstract Session: Treatment of Resistant Infections - Clinical Analyses
Thursday, October 5, 2017
Room: Poster Hall CD
  • IDweek poster - VRE vs VSE - Addisu .pdf (1.5 MB)
  • Background: Enterococci are commensal of the gastrointestinal tract known to cause blood stream infections (BSIs). Studies have shown increased mortality from enterococcal BSI in neutropenic patients, indicating Vancomycin resistant Enterococcal (VRE) infections causing increased mortality. Whether these differences in mortality apply to AML patients is unknown. The objectives of this study are to compare the risk factors and outcomes between VRE & VSE BSIs in AML patients.

    Methods:We conducted a single center, retrospective cohort study of patients with enterococcal BSIs at H. Lee Moffitt Cancer Center from July 2011 to October 2015. Records were searched to identify AML patients with enterococcal BSI. Enterococcal species, neutropenia duration, Vancomycin exposure, VRE colonization, 7 and 30 day mortality, age, sex, length of stay, stem cell transplant & central line status were compared. We conducted statistical tests & Kaplan-Meier plot to analyze mortality trends.

    Results:There were a total of 77 AML patients with enterococcal BSI. Forty-two (54.5%) were caused by VRE. E. faecalis & E. faecium accounted for 28.5% & 62.3% of BSI respectively. The E. faecalis isolates were more likely to be VSE (83% vs. 8.3 %, p<0.001) and E. fecium isolates to be VRE (71% vs. 29%, p<0.001). Duration of neutropenia was significantly longer (27.3 vs. 20.7 days, P<0.005) among AML patients with VRE BSI. Recent Vancomycin use and VRE colonization were significantly associated with VRE BSI. There were no significant differences in duration of bacteremia, length of stay and 7 & 30-day mortality between VRE vs. VSE BSI.

    Conclusion: Enterococcal infections among AML patients are significantly more likely to be caused by Vancomycin resistant E. faecium. The risk is increased by VRE colonization and Vancomycin exposure. The absence of statistical difference in 7 or 30-day mortality between VRE & VSE enterococcal BSI in our AML patients could indicate that in a homogenous group of patients, host and treatment related factors may influence mortality more than species or susceptibility of the isolates. Our finding confirms VRE colonization as risk factor of VRE BSI for AML patients. This finding is important for future patient education and development of preventive and treatment protocols.

    Anteneh Addisu, MD, PhD, Infectious Diseases, University of South Florida, Tampa, FL, Noah Hackney, MS, Medicine, University of South Florida, Tampa, FL, Somya Nanjappa, MD, Internal Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, Asima Cheema, MD, Internal Medicine, University of South Florida, Tampa, FL and John Greene, MD, FACP, Infectious Diseases, H. Lee Moffitt Cancer Center, Tampa, FL


    A. Addisu, None

    N. Hackney, None

    S. Nanjappa, None

    A. Cheema, None

    J. Greene, None

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