Prevention of peritransplantation viridans streptococcal bacteremia with early vancomycin administration: A single-center observational cohort study Journal Article

  


Authors: Jaffe, D.; Jakubowski, A.; Sepkowitz, K.; Sebti, R.; Kiehn, T. E.; Pamer, E.; Papanicolaou, G. A.
Article Title: Prevention of peritransplantation viridans streptococcal bacteremia with early vancomycin administration: A single-center observational cohort study
Abstract: Background. Viridans streptococcal bacteremia (VSB) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with substantial mortality. Prevention of this serious complication is therefore a high priority. The objective of this study was to evaluate the effect of early vancomycin administration on rates and outcomes of VSB. Methods. We analyzed the effect of early vancomycin on the incidence of VSB in a cohort of 430 consecutive HSCTs performed during the period of 1 January 1998 to 30 September 2002. The primary end point was time to diagnosis of VSB. Early vancomycin was defined as ≥2 doses of vancomycin between days -7 through +7 after HSCT or diagnosis of VSB, whichever occurred first. Risk factors for VSB were identified in univariate and multivariate Cox proportional hazard models. Results. The incidence of VSB in the cohort was 7.4%. The incidence of VSB in patients who did not receive early vancomycin was 24.8%, compared with 0.3% in patients who did (P<.001). Additional risk factors were female sex, conditioning with total body irradiation, and diagnosis of chronic myelogenous leukemia. Conclusions. The attributable mortality rate for VSB in our cohort was 21%. Early vancomycin was associated with decreased VSB (hazard ratio, 0.02; 95% confidence interval, 0.003-0.19) after controlling for age, sex, underlying disease, and transplantation variables. The benefits of vancomycin prophylaxis for the prevention of VSB and associated mortality need to be evaluated in a prospective clinical trial.
Keywords: adolescent; adult; child; aged; child, preschool; middle aged; major clinical study; mortality; dose response; cohort studies; incidence; risk factors; hematopoietic stem cell transplantation; chronic myeloid leukemia; risk factor; time factors; anti-bacterial agents; whole body radiation; infant; allogeneic hematopoietic stem cell transplantation; bacteremia; vancomycin; gender; antibiotic prophylaxis; streptococcal infections; alpha hemolytic streptococcus; viridans streptococci; nonbiological model; humans; human; male; female; priority journal; article; viridans streptococcal bacteremia
Journal Title: Clinical Infectious Diseases
Volume: 39
Issue: 11
ISSN: 1058-4838
Publisher: Oxford University Press  
Date Published: 2004-12-01
Start Page: 1625
End Page: 1632
Language: English
DOI: 10.1086/425612
PROVIDER: scopus
PUBMED: 15578362
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-9644260655&partnerID=40&md5=a8ff261188aeea0adba831504ad747dd
Notes: Clin. Infect. Dis. -- Cited By (since 1996):14 -- Export Date: 16 June 2014 -- CODEN: CIDIE -- Source: Scopus
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MSK Authors
  1. Dana Jaffe
    13 Jaffe
  2. Kent A Sepkowitz
    273 Sepkowitz
  3. Eric Pamer
    283 Pamer
  4. Genovefa A Papanicolaou
    238 Papanicolaou
  5. Ann Jakubowski
    457 Jakubowski
  6. Timothy E Kiehn
    101 Kiehn
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