Risk factors for enterococcal bacteremia in allogeneic hematopoietic stem cell transplant recipients

Area of Science:

• Hematology
• Infectious Diseases
• Transplant Medicine

Background:

• Bacteremia is a significant cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients.
• Enterococci are frequently isolated pathogens in this vulnerable patient population.

Purpose of the Study:

• To identify risk factors associated with enterococcal bacteremia within 30 days post-allogeneic HSCT.
• To inform preventative strategies and clinical management for HSCT patients.

Main Methods:

• Retrospective case-control study involving 306 patients undergoing allogeneic HSCT.
• Analysis of risk factors including donor/transplant type, mucositis, colonization, and prior antibiotic therapy.
• Calculation of odds ratios (OR) with 95% confidence intervals (CI) for identified variables.

Main Results:

• 33 patients developed enterococcal bacteremia (cumulative incidence 10.8%), with a median onset of 9 days post-HSCT.
• Significant risk factors identified: mismatched related/cord blood transplants, severe mucositis (grades 3-4), pharyngeal enterococcal colonization, and prior cephalosporin therapy.
• Protective factors: higher Karnofsky score (≥50) and prior glycopeptide therapy.

Conclusions:

• Enterococcal bacteremia is a frequent complication following allogeneic HSCT.
• Key risk factors include specific transplant types, severe mucositis, pharyngeal colonization, and cephalosporin use.
• Good patient condition and vancomycin use are associated with a reduced risk of enterococcal bacteremia.