Recurrent Enterococcal Bloodstream Infection in Patients with Acute Leukemia. (4th October 2017)

• Record Type: Journal Article
• Authors: Messina, Julia; Sung, Anthony; Alexander, Barbara D; Chao, Nelson
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S552
• Page End: S553
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.1436
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: Enterococcal bloodstream infection (EBSI) is common in patients with acute leukemia (AL) & is associated with significant morbidity and mortality. Chemotherapy-induced mucositis and antimicrobial-induced gut dysbiosis may place patients at risk for recurrent EBSI (REBSI). However, rates of and risk factors for REBSI in AL have not been described. Methods: We performed a retrospective cohort study of AL patients with EBSI from 2010–2015. EBSI was defined by >=1 positive blood culture for E. faecium or faecalis and fever (>=38 °C), hypotension, or chills. Clearance was defined by >=1 negative culture >=48 hours after last positive culture. REBSI was defined by a positive blood culture >=72 hours after clearance. Categorical variables were reported as proportions and compared by χ2 test. Continuous variables were summarized by median and interquartile range and compared by Wilcoxon Rank-sum Test. P < 0.05 was considered significant. Results: 73 patients had EBSI with 23 (32%) having >=1 episode of REBSI (Table 1). Median time to REBSI was 15 days (11–44). Patients with REBSI had significantly longer durations of fever and neutropenia. There were no significant differences between time to appropriate enterococcal therapies (most commonly daptomycin), removal of vascular catheters, or metastatic infection between groups. E. faecium was the most common infecting pathogen in cases of REBSI (96%), and 41% of these isolates were daptomycin non-susceptible enterococci (DNSE) following daptomycin therapy for preceding in EBSI. Conclusion: REBSI with E. feacium is common in AL and tends to occur within the first 30 days of EBSI therapy. Duration of fever and neutropenia with EBSI may prove useful in determining risk for REBSI. Susceptibility patterns can change with REBSI based on preceding EBSI therapy with the emergence of DNSE. Disclosures: All authors: No reported disclosures.