Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia.
Abstract
Rates and risk factors for recurrent enterococcal bloodstream infection (R-EBSI) and
whether the same genetic lineage causes index EBSI and R-EBSI are unknown in patients
with acute leukemia (AL) receiving chemotherapy.Ninety-two AL patients with EBSI from
2010 to 2015 were included. Enterococcal bloodstream infection was defined by 31 positive
blood cultures for Enterococcus faecium or Enterococcus faecalis and fever, hypotension,
or chills. Clearance was defined by 31 negative cultures 324 hours after last positive
culture and defervescence. Recurrent enterococcal bloodstream infection was defined
by a positive blood culture for Enterococcus 324 hours after clearance. Categorical
variables were reported as proportions and compared by the χ2 test. Continuous variables
were summarized by median and interquartile range (IQR) and compared by the Wilcoxon-Mann-Whitney
Test. P values <.05 were considered significant. Whole-genome sequencing was performed
on available paired BSI isolates from 7 patients.Twenty-four patients (26%) had 31
episodes of R-EBSI. Median time to R-EBSI (IQR) was 26 (13-50) days. Patients with
R-EBSI had significantly longer durations of fever and metronidazole exposure during
their index EBSI. Thirty-nine percent of E. faecium R-EBSI isolates became daptomycin-nonsusceptible
Enterococcus (DNSE) following daptomycin therapy for index EBSI. Whole-genome sequencing
analysis confirmed high probability of genetic relatedness of index EBSI and R-EBSI
isolates for 4/7 patients.Recurrent enterococcal bloodstream infection and DNSE are
common in patients with AL and tend to occur within the first 30 days of index EBSI.
Duration of fever and metronidazole exposure may be useful in determining risk for
R-EBSI. Whole-genome sequencing analysis demonstrates that the same strain causes
both EBSI and R-EBSI in some patients.
Type
Journal articleSubject
Enterococcusacute leukemia
daptomycin-nonsusceptible Enterococcus
recurrent bloodstream infection
whole-genome sequencing
Permalink
https://hdl.handle.net/10161/18163Published Version (Please cite this version)
10.1093/ofid/ofy107Publication Info
Messina, Julia A; Sinha, Rohita; Starr, Kimberly; Arshad, Mehreen; Alexander, Barbara
D; Chao, Nelson J; & Sung, Anthony D (2018). Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection
in Patients With Acute Leukemia. Open Forum Infectious Diseases, 5(6). pp. ofy107. 10.1093/ofid/ofy107. Retrieved from https://hdl.handle.net/10161/18163.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Barbara Dudley Alexander
Professor of Medicine
Clinical research related to infectious complications of solid organ and bone marrow
transplantation, with a particular interest in the treatment and rapid diagnosis of
fungal disease. Training the next generation of Transplant Infectious Disease Physicians
is a special focus of mine as the Principal Investigator of our Interdisciplinary
T32 Training Program funded the NIH.
Mehreen Arshad
Assistant Professor of Pediatrics
Nelson Jen An Chao
Donald D. and Elizabeth G. Cooke Cancer Distinguished Research Professor
My research interests are in two broad areas, clinical hematopoietic stem cell and
cord blood transplantation and in the laboratory studies related to graft vs. host
disease and immune reconstitution. On the clinical side we are currently conducting
approximately 50 different clinical protocols ranging from preparatory regimens, supportive
care studies and disease specific protocols. Most of these clinical studies are centered
around studies of the sources of stem cells and the methods to
Julia Antoinette Messina
Assistant Professor of Medicine
I am a Transplant Infectious Diseases Physician who specializes in the care of immunocompromised
patients including solid organ and bone marrow transplant recipients and patients
with HIV. My research interests are in infections and clinical outcomes in patients
with hematologic malignancies.
Anthony D Sung
Associate Professor of Medicine
I am dedicated to the treatment of hematologic malignancies through cellular therapies
such as hematopoietic stem cell transplantation (HCT). My research focuses on strategies
to reduce complications of HCT and ranges from preclinical studies using murine models
of HCT to Phase 1 and Phase 2 clinical trials. Areas of interest include the role
of the microbiota (the trillions of bacteria living in and on our bodies), nutrition,
and exercise in modulating HCT outcomes such as graft-versus-host
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info