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Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia.

dc.contributor.author Messina, Julia
dc.contributor.author Sinha, Rohita
dc.contributor.author Starr, Kimberly
dc.contributor.author Arshad, Mehreen
dc.contributor.author Alexander, Barbara D
dc.contributor.author Chao, Nelson J
dc.contributor.author Sung, Anthony D
dc.date.accessioned 2019-03-19T14:43:18Z
dc.date.available 2019-03-19T14:43:18Z
dc.date.issued 2018-06
dc.identifier ofy107
dc.identifier.issn 2328-8957
dc.identifier.issn 2328-8957
dc.identifier.uri https://hdl.handle.net/10161/18163
dc.description.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.
dc.language eng
dc.publisher Oxford University Press (OUP)
dc.relation.ispartof Open Forum Infectious Diseases
dc.relation.isversionof 10.1093/ofid/ofy107
dc.subject Enterococcus
dc.subject acute leukemia
dc.subject daptomycin-nonsusceptible Enterococcus
dc.subject recurrent bloodstream infection
dc.subject whole-genome sequencing
dc.title Clinical and Genomic Characterization of Recurrent Enterococcal Bloodstream Infection in Patients With Acute Leukemia.
dc.type Journal article
dc.date.updated 2019-03-19T14:43:17Z
pubs.begin-page ofy107
pubs.issue 6
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Medicine, Infectious Diseases
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.publication-status Published
pubs.volume 5
duke.contributor.orcid Messina, Julia|0000-0001-6411-198X


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