Impact of empiric treatment for vancomycin-resistant enterococcus in colonized patients early after allogeneic hematopoietic stem cell transplantation Journal Article


Authors: Kamboj, M.; Cohen, N.; Huang, Y. T.; Kerpelev, M.; Jakubowski, A.; Sepkowitz, K. A.; Papanicolaou, G. A.; Seo, S. K.
Article Title: Impact of empiric treatment for vancomycin-resistant enterococcus in colonized patients early after allogeneic hematopoietic stem cell transplantation
Abstract: In recent years, vancomycin-resistant Enterococcus (VRE) colonization is being increasingly encountered in transplant recipients, and VRE has become one of the leading causes of bacteremia early after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data are sparse on the effect of empiric VRE therapy for febrile, neutropenic allo-HSCT recipients colonized with VRE. All allo-HSCT recipients aged ≥18years who developed VRE bacteremia (VREB) between 2005 and 2014 were identified and categorized as to whether they received empiric or directed VRE therapy. There were 434 (33%) VRE-colonized and 872 (67%) non-VRE-colonized patients during the study period, and 172 of the 434 (40%) VRE-colonized patients received empiric therapy. There was no significant difference in incidence of VREB among colonized patients who did or did not receive empiric therapy (28 of 172 [16%] vs 55 of 262 [21%]; P =.22). There were 95 patients with VREB, of which the majority (83 of 95; 87%) was known to be VRE-colonized. Of the 95 VREB episodes, 29 (31%) were treated with empiric VRE therapy, whereas 66 (69%) were treated with directed therapy. No significant differences in clinical outcomes, including median duration of bacteremia (2 days vs 2 days; P =.39), recurrent VREB (3 of 29 [10%] vs 5 of 66 [8%]; P =.65), 30-day all-cause mortality (1 of 29 [3%] vs 4 of 66 [6%]; P =.62), or VRE-attributable mortality (1 of 29 [3%] vs 1 of 66 [2%]; P =.55), were observed between the empiric therapy and directed therapy groups. Kaplan-Meier curve analysis showed no significant difference in survival at 30days in allo-HSCT recipients with VREB who received empiric therapy and those who received directed therapy (97% vs 94%; P =.62). Based on our data, we recommend against empiric use of VRE-active agents for fever and neutropenia in VRE-colonized patients undergoing allo-HSCT. © 2018 American Society for Blood and Marrow Transplantation
Keywords: adult; controlled study; aged; antibiotic agent; antibiotic therapy; major clinical study; incidence; cancer therapy; acute leukemia; myelodysplastic syndrome; allogeneic hematopoietic stem cell transplantation; disease duration; bacteremia; graft survival; bacterial colonization; vancomycin resistant enterococcus; linezolid; vancomycin; vancomycin-resistant enterococcus; enterococcal infection; piperacillin plus tazobactam; cefepime; clinical outcome; daptomycin; human; male; female; article; all cause mortality; empiric treatment; fever and neutropenia
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 3
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-03-01
Start Page: 594
End Page: 598
Language: English
DOI: 10.1016/j.bbmt.2018.11.008
PUBMED: 30448456
PROVIDER: scopus
PMCID: PMC6445740
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Kent A Sepkowitz
    265 Sepkowitz
  2. Susan Seo
    72 Seo
  3. Mini Kamboj
    81 Kamboj
  4. Yao-Ting Huang
    28 Huang