Effect of vancomycin on the incidence of early S. viridans bacteremia (SVB) after allogeneic stem cell transplantation (HSCT) Meeting Abstract

  


Authors: Jaffe, D.; Sepkowitz, K.; Pamer, E.; Small, T.; Papanicolaou, G.
Abstract Title: Effect of vancomycin on the incidence of early S. viridans bacteremia (SVB) after allogeneic stem cell transplantation (HSCT)
Meeting Title: 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy
Abstract: Background: During 1998-2002, the incidence of early SVB after HSCT at MSKCC was 7%. Previously, vancomycin prophylaxis was shown to decrease incidence of Gram positive infections. 71% of our HSCT pts received any vancomycin (V) empirically or therapeutically during day -7 to +7 post HSCT. We examined the effect of V on the incidence of SVB in a prospective cohort of 430 allo HSCT at MSKCC during 1998-2002. Methods: A prospective cohort study. Second HSCT were tabulated as new pts. Vancomycin use during day -7 to +7 or until SVB (whichever occurred first) was obtained from pharmacy records. Cox proportional hazards analysis was used to determine the association between V and SVB occurring during d -7 to +14. Results: Median age 34 yrs, female 42.8%, chronic myelocytic leukemia (CML) 13.3%, conditioning with total body irradiation (TBI) 65.4%, (TBI/thiotepa/fludarabine 14.9%). A total of 305 (71%) pts received V. SVB occurred in 2/305 (0.7%) pts who received V vs 30/125 (24%) pts who did not receive V(p<0.001). By univariate analysis risk factors for SVB were female sex, CML, PBSCT and TBI (p<0.01). Multivariate analysis is given. Conclusions: 1) Vancomycin resulted in a significant reduction in the incidence of SVB (0.7% vs 24%, p<0.001). 2) Conditioning with TBI/Thiotepa/fludarabine (HR 6.1) and CML (HR 2.2) remained significant risk factors for SVB in multivariate analysis. 3) The incidence of SVB in pts conditioned with TBI/Thiotepa/fludarabine who did not receive vancomycin was 75%. 4) Given the mortality of 22% associated with early SVB, a clinical trial addressing the role of vancomycin prophylaxis for the pts at highest risk will be considered.
Keywords: risk factor; time period 1998-2002
Journal Title: Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy
Volume: 43
Meeting Dates: 2003 Sep 14-17
Meeting Location: Chicago, IL
ISSN: 0733-6373
Publisher: American Society for Microbiology  
Date Published: 2003-09-01
Start Page: 373
Language: English
ACCESSION: BCI:BCI200400025926
PROVIDER: biosis
Notes: Meeting Abstract: K-771 -- 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy -- Chicago, IL, USA -- September 14-17, 2003 -- American Society for Microbiology -- Source: Biosis