Prevention of Peritransplantation Viridans Streptococcal Bacteremia with Early Vancomycin Administration: A Single-Center Observational Cohort Study

• Published in: Clinical infectious diseases Vol. 39; no. 11; pp. 1625 - 1632
• Main Authors: Jaffe, Dana, Jakubowski, Ann, Sepkowitz, Kent, Sebti, R., Kiehn, Timothy E., Pamer, Eric, Papanicolaou, Genovefa A.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.12.2004; University of Chicago Press
• Subjects: Adolescent; Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotic Prophylaxis; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia; Bacteremia - etiology; Bacteremia - prevention & control; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Bone marrow; Child; Child, Preschool; Chronic myeloid leukemia; Cohort Studies; Female; Fever; Hematopoietic Stem Cell Transplantation - adverse effects; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; Major Articles; Male; Medical sciences; Middle Aged; Mortality; Mucositis; Pharmacology. Drug treatments; Predisposing factors; Risk Factors; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcal Infections - etiology; Streptococcal Infections - prevention & control; Time Factors; Vancomycin - therapeutic use; Viridans Streptococci; Prognosis; Peptides; Stem cell; Hematopoietic cell; Homograft; Vancomycin; Epidemiology; Allogeneic system; Incidence; Prevention; Myeloproliferative syndrome; Glycopeptide; Surgery; Cohort study; Streptococcal infection; Chronic myelocytic leukemia; Graft; Complication; Female; Diagnosis; Hazard; Human; Mortality; Single dose; Malignant hemopathy; Method; Radiotherapy; Bacteremia; Infection; Antibiotic; Chronic; Cox model; Treatment; Polypeptide; Risk factor; Bacteriosis; Early; Antibacterial agent; Comparative study
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/425612

Background. Viridans streptococcal bacteremia (VSB) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with substantial mortality. Prevention of this serious complication is therefore a high priority. The objective of this study was to evaluate the effect of early vancomycin administration on rates and outcomes of VSB. Methods. We analyzed the effect of early vancomycin on the incidence of VSB in a cohort of 430 consecutive HSCTs performed during the period of 1 January 1998 to 30 September 2002. The primary end point was time to diagnosis of VSB. Early vancomycin was defined as ⩾2 doses of vancomycin between days -7 through +7 after HSCT or diagnosis of VSB, whichever occurred first. Risk factors for VSB were identified in univariate and multivariate Cox proportional hazard models. Results. The incidence of VSB in the cohort was 7.4%. The incidence of VSB in patients who did not receive early vancomycin was 24.8%, compared with 0.3% in patients who did (P < .001). Additional risk factors were female sex, conditioning with total body irradiation, and diagnosis of chronic myelogenous leukemia. Conclusions. The attributable mortality rate for VSB in our cohort was 21%. Early vancomycin was associated with decreased VSB (hazard ratio, 0.02; 95% confidence interval, 0.003–0.19) after controlling for age, sex, underlying disease, and transplantation variables. The benefits of vancomycin prophylaxis for the prevention of VSB and associated mortality need to be evaluated in a prospective clinical trial.