1017. Impact of Enterococcal Bloodstream Infection on Mortality in Patients with Acute Myelogenous Leukemia
Session: Poster Abstract Session: Bacteremia and Endocarditis
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • IDSA Poster_9-26-18(1) .pdf (162.3 kB)
  • Background: Though enterococcal bloodstream infection (EBSI) is common in patients with acute myelogenous leukemia (AML), its impact on mortality requires further elucidation. Our objectives were to: 1) determine attributable mortality to EBSI and 2) compare overall, 1-year, relapse-related mortality (RRM), and treatment-related mortality (TRM) between AML patients with and without EBSI.

    Methods: This was a retrospective cohort receiving intensive chemotherapy for AML from 2010-15. EBSI was defined by _1 positive blood culture for E. faecium or faecalis and fever, hypotension, or chills. Attributable mortality to EBSI was defined by failure to achieve BSI Clearance ( _1 negative culture _24 hr after last positive culture and defervescence) by the date of death. StudentÕs t-test was used to compare continuous variables, and C2 test was used for categorical variables. Kaplan-Meier was used for survival analyses (unadjusted), and p-values were computed by log-rank.

    Results: 308 patients were identified during the study period: 80 with EBSI and 228 without EBSI. 5/80 patients died with EBSI (6%) although 4/5 patients had concurrent infections at the time of death (C. diff colitis, candidemia, proven invasive aspergillosis, and probable invasive fungal disease, respectively). There were no significant differences between overall and 1-year mortality (Table 1). In the survival analyses, EBSI did not significantly impact overall survival, 1-year mortality, RRM, and TRM (Figure 1). However, patients with vancomycin-resistant EBSI (VRE) trended toward increased overall mortality.

    Conclusion: Attributable mortality to EBSI is uncommon (6%) in AML. Additionally, EBSI does not significantly impact mortality in this vulnerable patient population that already has very high rates of RRM and TRM. However, as EBSI inflicted 26% of patients over the course of this study period, further investigation is needed to elucidate the morbidity suffered from this common infection and identify potentially modifiable risk factors.

    Table 1.

    EBSI

    N=80 (26%)

    No EBSI

    N=228 (74%)

    P

    Age AML Diagnosis (median yrs, IQR)

    63

    (51-69)

    61

    (50-69)

    0.93

    Overall Mortality (%)

    63/73 (86)

    154/198 (77)

    0.12

    Time AML Diagnosis to Death (median yrs, IQR)

    220 (67-541)

    273 (62-582)

    0.16

    Julia Messina, MD1, Marion Hemmersbach Miller, MD, PhD2, Anthony Sung, MD3, Barbara D. Alexander, MD, MHS1 and Nelson Chao, MD, MBA3, (1)Division of Infectious Diseases, Duke University Medical Center, Durham, NC, (2)Duke University, Durham, NC, (3)Hematologic Malignancies and Cellular Therapy, Duke University, Durham, NC

    Disclosures:

    J. Messina, None

    M. Hemmersbach Miller, None

    A. Sung, Merck: Grant Investigator , Grant recipient . Enterome: Grant Investigator , Grant recipient .

    B. D. Alexander, None

    N. Chao, None

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