Hostname: page-component-78c5997874-g7gxr Total loading time: 0 Render date: 2024-11-09T19:20:52.516Z Has data issue: false hasContentIssue false
  • English
  • Français

Incidence of, and Risk Factors for, Nosocomial Infections Among Hematopoietic Stem Cell Transplantation Recipients, With Impact on Procedure-Related Mortality

Published online by Cambridge University Press:  02 January 2015

Carlo Marena ,
Marco Zecca ,
Maria Luisa Carenini ,
Angela Bruschi ,
Maria Luigia Bassi ,
Pietro Olivieri ,
Silvia Azzaretti  and
Franco Locatelli
Carlo Marena*
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Marco Zecca
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Maria Luisa Carenini
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Angela Bruschi
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Maria Luigia Bassi
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Pietro Olivieri
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Silvia Azzaretti
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
Franco Locatelli
Affiliation:
Infection Control Committee, Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, and Institute of Hygiene, University of Pavia, Italy
*
Infection Control Committee, San Matteo Hospital, Viale Golgi 19, 27100 Pavia, Italy
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To determine the incidence of, and risk factors for, nosocomial infections (NIs) occurring among hematopoietic stem cell transplantation (HSCT) recipients during hospitalization and to evaluate the impact of these NIs on patient outcome.

Design:

A two-year prospective observational study in two HSCT units.

Patients:

All patients admitted to the HSCT units between February 1997 and March 1999.

Setting:

A teaching hospital.

Methods:

After admission to the HSCT units, the patients were followed prospectively on a daily basis to collect all pertinent variables for the development of NIs.

Results:

49 NIs were identified in 34 of the 143 patients screened. The incidence of NIs and infected patients was 34.2% and 23.7%, respectively. The incidence density of NI was 8.96 per 1,000 patient-days. The most frequent NIs were bloodstream infections ([BSIs], 42.8%) and respiratory tract infections (28.6%). Other sites involved were as follows: eye (8.2%), urinary tract (6.1%), gastrointestinal tract (6.1%), skin (4.1%), ear (2%), and central venous catheter ([CVC], 2%). Because of the predominance and clinical relevance of BSIs, we examined both intrinsic and extrinsic risk factors associated with these infections. Independent risk factors for BSIs were allograft from matched unrelated or partially matched family donor, graft-versus-host disease (GVHD) prophylaxis without methotrexate (MTX), type of CVC, and duration of total parenteral nutrition. Four variables were independently associated with mortality occurring during hospitalization: culture-proven BSIs, advanced disease phase at transplant, type of transplant, and absence of MTX for GVHD prophylaxis.

Conclusions:

The study identified several factors associated with increased risk of BSIs among HSCT patients. Because BSIs are life-threatening complications for HSCT recipients, preventive measures aimed at reducing the incidence of these infections among patients given HSCT should be adopted.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 8 , August 2001 , pp. 510 - 517
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Sorely, JS, Shea, TC. Prevention of infections in bone marrow transplant recipients. Infect Dis Clin North Am 1997;11:459–477.Google Scholar
2. Ochs, L, Shu, XO, Miller, J, Enright, H, Wagner, J, Filipovich, A, et al. Late infections after allogeneic bone marrow transplantation: comparison of incidence in related and unrelated donor transplant recipients. Blood 1995;86:3979–3986.CrossRefGoogle ScholarPubMed
3. Poliquin, CM. Post-bone marrow transplant patient management. Yale J Biol Med 1990;63:495–502.Google Scholar
4. Zembower, T. Epidemiology of infection complications in cancer patients. Cancer Treat Res 1998;96:33–75.Google Scholar
5. Schimpff, SC, Young, VM, Greene, WH, Vermeulen, GD, Moody, MR, Wiernik, PH. Origin of infections in acute non-lymphocytic leukemia: significance of hospital acquisition of potential pathogens. Ann Intern Med 1972;77:707–714.Google Scholar
6. Daw, MA, MacMahon, E, Keane, CT. Surveillance cultures in neutropenic patients. J Hosp Infect 1988;12:251–261.Google Scholar
7. Barnes, RJ. Infection prophylaxis. In: Barrett, J, Treleaven, J, eds. Bone Marrow Transplantation in Practice. London, UK: Churchill Livingstone; 1992:289–297.Google Scholar
8. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definition for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
9. Armitage, JO. Bone marrow transplantation. N Engl J Med 1994;330:827–838.CrossRefGoogle ScholarPubMed
10. Gratwohl, A, Gahrton, G. Allogeneic bone marrow transplantation in leukemia. Acta Oncol 1988;27:557–565.CrossRefGoogle ScholarPubMed
11. Barrett, AJ, Horowitz, MM, Gale, RP, Biggs, JC, Camitta, BM, Dicke, KA, et al. Marrow transplantation for acute lymphoblastic leukemia: factors affecting relapse and survival. Blood 1989;74:826–871.Google Scholar
12. Santos, GW. Marrow transplantation in acute non-lymphocytic leukemia. Blood 1989;74:901–908.Google Scholar
13. Glucksberg, H, Storb, R, Fefer, A, Buckner, CD, Neiman, PE, Clift, RA, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HLA-matched sibling donors. Transplantation 1974;18:295–304.Google Scholar
14. Bearman, SI, Appelbaum, FR, Back, A, Petersen, FB, Buckner, CD, Sullivan, KM, et al. Regimen-related toxicity in patients undergoing bone marrow transplantation. J Clin Oncol 1988;6:1562–1568.CrossRefGoogle ScholarPubMed
15. Jarvis, WR, Cookson, ST, Robles, MB. Prevention of nosocomial bloodstream infections: a national and international priority. Infect Control Hosp Epidemiol 1996;17:272–275.Google Scholar
16. Kruger, W, Russmann, B, Kroger, N, Salomon, C, Ekopf, N, Eisner, HA, et al. Early infections in patients undergoing bone marrow or blood stem cell transplantation: a seven year single centre investigation of 409 cases. Bone Marrow Transplant 1999;23:589–597.Google Scholar
17. Sparrelid, E, Hagglund, H, Remberger, M, Ringden, O, Lonnqvist, B, Ljungman, P, et al. Bacteremia during the aplastic phase after allogeneic bone marrow transplantation is associated with early death from invasive fungal infection. Bone Marrow Transplant 1998;22:795–800.Google Scholar
18. Engels, EA, Ellis, CA, Supran, SE, Schmid, CH, Barza, M, Schenkein, DP, et al. Early infection in bone marrow transplantation: quantitative study of clinical factors that affect risk. Clin Infect Dis 1999;28:256–266.CrossRefGoogle ScholarPubMed
19. Asian, T, Anaissie, EJ. Infections in hematological malignancies. In: Freireich, EG, Kantarjian, HM, eds. Medical Management of Hematological Malignant Diseases. New York, NY: Marcel Dekker; 1998:321.Google Scholar
20. Pizzo, PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med 1993;328:1323–1332.Google Scholar
21. Pearson, ML. Guideline for prevention of intravascular device-related infections: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:438–473.Google Scholar
22. Storb, R, Deeg, HJ, Whitehead, J, Appelbaum, F, Beatty, P, Bensinger, W, et al. Methotrexate and cyclosporine compared with cyclosporine alone for prophylaxis of acute graft versus host disease after marrow transplantation for leukemia. N Engl J Med 1986;314:729–735.Google Scholar
23. Storb, R, Leisenring, W, Deeg, HJ, Anasetti, C, Appelbaum, F, Bensinger, W, et al. Long-term follow-up of a randomized trial of graft-versus-host disease prevention by methotrexate/cyclosporine versus methotrexate alone in patients given marrow grafts for severe aplastic anemia. Blood 1994;83:2749–2750.CrossRefGoogle ScholarPubMed
24. Barrett, JA. Graft-versus-host disease. In: Barrett, JA, Treleaven, J, eds. Bone Marrow Transplantation in Practice. London, UK: Churchill Linvingstone; 1992:257–272.Google Scholar
25. Baughen, R. Nutrition for leukaemia patients. Nursing Standard 1988;6:22–23.Google Scholar
26. Nosanchuk, JD, Sepkowitz, KA, Pearse, RN, White, MH, Nimer, SD, Armstrong, D. Infection complications of autologous bone marrow and peripheral stem cell transplantation for refractory leukemia and lymphoma. Bone Marrow Transplant 1996;18:355–359.Google Scholar
27. Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320–324.CrossRefGoogle ScholarPubMed
28. Mossad, SB, Longworth, DL, Goormastic, M, Serkey, JM, Keys, TF, Bolwell, BJ. Early infectious complications in autologous bone marrow transplantation: a review of 219 patients. Bone Marrow Transplant 1996;18:265–271.Google Scholar
29. Bensinger, WI, Clift, R, Martin, P, Appelbaum, FR, Demirer, T, Gooley, T, et al. Allogeneic peripheral blood stem cell transplantation in patients with advanced haematological malignancies: a retrospective comparison with marrow transplantation. Blood 1996;88:2794–2800.Google Scholar
30. Ottinger, HD, Beelen, DW, Scheulen, B, Schaefer, UW, Grosse-Wilde, H. Improved immune reconstitution after allotransplantation of peripheral blood stem cells instead of bone marrow. Blood 1996;88:2775–2779.Google Scholar
31. Harris, DT, Schumacher, MJ, LoCascio, J, Besencon, FJ, Olson, GB, DeLuca, D, et al. Phenotypic and functional immaturity of human umbilical cord blood lymphocytes. Proc Natl Acad Sci 1992;89:10006–10010.CrossRefGoogle Scholar
32. Locatelli, F, Rocha, V, Chastang, C, Arcese, W, Michel, G, Abecasis, M, et al. Factors associated with outcome after cord blood transplantation in children with acute leukemia. Blood 1999;93:3662–3671.Google ScholarPubMed
33. Kernan, NA, Bartsch, G, Ash, RC, Beatty, PG, Champlin, R, Filipovich, A, et al. Analysis of 462 transplantations from unrelated donors facilitated by the National Marrow Donor Program. N Engl J Med 1993;328:593–602.Google Scholar
34. Sierra, J, Storer, B, Hansen, JA, Bjerke, JW, Martin, PJ, Petersdorf, EW, et al. Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: the effect of leukemic burden, donor HLA-matching, and marrow cell dose. Blood 1997;89:4226–4235.Google Scholar