Prediction of Bloodstream Infection due to Vancomycin-Resistant Enterococci in Patients Undergoing Leukemia Induction or Hematopoietic Stem Cell Transplantation.
Clin Infect Dis. 2017 Mar 20;:
Authors: Webb BJ, Healy R, Majers J, Burr Z, Gazdik M, Lopansri B, Hoda D, Petersen FB, Ford C
Background.: Bloodstream infection (BSI) due vancomycin-resistant Enterococcus (VRE) is an important complication of hematologic malignancy. Determining when to use empiric anti-VRE antibiotic therapy in this population remains a clinical challenge.
Methods.: A single-center cohort representing 664 admissions for induction or hematopoietic stem cell transplant (HSCT) from 2006-2014 was selected. We derived a prediction score using risk factors for VRE BSI and evaluated the model's predictive performance by calculating it for each of 16,232 BSI at-risk inpatient days.
Results.: VRE BSI incidence was 6.5% of admissions (2.7 VRE BSI per 1000 BSI at-risk days). Adjusted 1-year mortality and length of stay were significantly higher in patients with VRE BSI. VRE colonization (AOR 8.4, 95% CI 3.4-20.6, p<0.0001), renal insufficiency (AOR 2.4, 95% CI 1.0-5.8, p=0.046), aminoglycoside use (AOR 4.7, 2.2-9.8, p<0.0001), and anti-anaerobic antibiotic use (AOR 2.8, 1.3-5.8, p=0.007) correlated most closely with VRE BSI. A prediction model with optimal performance included these factors plus gastrointestinal disturbance, severe neutropenia and prior beta-lactam antibiotic use. The score effectively risk-stratified patients (AUROC 0.84, 95% CI 0.79-0.89). At a threshold of ≥5 points, per day probability of VRE BSI was increased nearly four-fold.
Conclusion.: This novel predictive score is based on risk factors reflecting a plausible pathophysiological model for VRE BSI. Integrating VRE colonization status with risk factors for developing BSI is a promising method of guiding rational use of empiric anti-VRE antimicrobial therapy in patients with hematological malignancy. Validation of this novel predictive score is needed to confirm clinical utility.
PMID: 28369204 [PubMed - as supplied by publisher]