1906. Recurrent Enterococcal Bloodstream Infection in Patients with Acute Leukemia
Session: Poster Abstract Session: Clinical: Bacteremia and Endocarditis
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • IDSA Poster_9-22-17 .pdf (970.6 kB)
  • Background: Enterococcal bloodstream infection (EBSI) is common in patients with acute leukemia (AL) & is associated with significant morbidity & mortality. Chemotherapy-induced mucositis & antimicrobial-induced gut dysbiosis may place patients at risk for recurrent EBSI (REBSI). However, rates of & risk factors for REBSI in AL have not been described.

    Methods: We performed a retrospective cohort study of AL patients with EBSI from 2010-2015. EBSI was defined by >=1 positive blood culture for E. faecium or faecalis& fever (>=38 °C), hypotension, or chills. Clearance was defined by >=1 negative culture >=48 hours after last positive culture. REBSI was defined by a positive blood culture >=72 hours after clearance. Categorical variables were reported as proportions & compared by χ2 test. Continuous variables were summarized by median & interquartile range & compared by Wilcoxon Rank Sum Test. P<0.05 was considered significant.

    Results: 73 patients had EBSI with 23 (32%) having >=1 episode of REBSI (Table 1). Median time to REBSI was 15 days (11-44). Patients with REBSI had significantly longer durations of fever & neutropenia. There were no significant differences between time to appropriate enterococcal therapies (most commonly daptomycin), removal of vascular catheters, or metastatic infection between groups. E. faecium was the most common infecting pathogen in cases of REBSI (96%), and 41% of these isolates were daptomycin non-susceptible enterococci (DNSE) following daptomycin therapy for preceding in EBSI.

    Conclusion: REBSI with E. feacium is common in AL & tends to occur within the first 30 days of EBSI therapy. Duration of fever & neutropenia with EBSI may prove useful in determining risk for REBSI. Susceptibility patterns can change with REBSI based on preceding EBSI therapy with the emergence of DNSE.

    Table 1

    Characteristic

    No REBSI

    N=50; 69%

    REBSI

    N=23; 32%

    P

    Female

    20 (40)

    10 (44)

    Age (years)

    59 (43-69)

    63 (49-68)

    AML

    ALL

    40 (80)

    10 (20)

    20 (87)

    3 (13)

    >=3 Chemotherapy Cycles

    12 (24)

    5 (22)

    Days of Fever

    3 (1-5)

    6 (0)

    .02

    Days of Neutropenia

    (absolute neutrophil count <500/mm3)

    22 (17-32)

    51 (22-66)

    .01

    BSI Duration (Days)

    2 (1-4)

    2.5 (2-5)

    E. faecium

    E. faecalis

    45 (90)

    5 (10)

    19 (83)

    4 (17)

    Resistance

    Ampicillin

    Vancomycin

    Daptomycin

    40 (80)

    37 (74)

    2 (4)

    15 (65)

    13 (57)

    2 (9)

    Death

    EBSI

    Other (<30 days)

    7 (14)

    10 (20)

    3 (13)

    0

    .9

    .02

    Julia Messina, MD1, Anthony Sung, MD2, Barbara D. Alexander, MD, MHS, FIDSA1 and Nelson Chao, MD, MBA2, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC

    Disclosures:

    J. Messina, None

    A. Sung, None

    B. D. Alexander, None

    N. Chao, None

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