Impact of Enterococcus infection in HSCT recipients: a national analysis

Background: Enterococci are the third most common cause of healthcare-associated infections in the United States, affecting 10-12% of all transplant recipients worldwide. Enterococcal bacteremia complicates the post-transplant recovery and raises mortality to 18%. This study aims to identify factors linked to mortality in hematopoietic stem cell transplant (HSCT) recipients with Enterococcus infection. Methods: We conducted a retrospective analysis using the National Inpatient Sample Database (2018-2021). Adults treated with HSCT and admitted for Enterococcus infection were identified using ICD-10 codes. The analysis utilized descriptive statistics and multivariate regression, with significance at a p-value ≤0.05. Results: A total of 40,462 HSCT patients, 1.3% were admitted with Enterococcus infection. The crude mortality rate was higher in the Enterococcus cohort than in the non-Enterococcus cohort (10.4% vs. 4.6%); however, the mortality risk was substantially lower in the Enterococcus cohort (p<0.001). In the Enterococcus cohort, patients with fungal infections, sepsis, acute respiratory failure, and those with invasive ventilation had a high mortality risk (p<0.05). In leukemia patients treated with HSCT, the Enterococcus cohort had higher mortality than the non-Enterococcus cohort (12.5% vs. 5.0%; aOR 1.8, 95% CI 1.9-2.6, p=0.005). Conclusions: In HSCT recipients, Enterococcus infection is a clinical marker for poor prognosis. Early broad-spectrum antibiotic therapy is essential for patients with sepsis, respiratory compromise, and fungal co-infections. Additionally, a multidisciplinary team is crucial for managing respiratory and renal failure.