To investigate a perceived increase in central venous catheter (CVC)–associated bloodstream infections (BSIs) among pediatric hematology–oncology outpatients.

A case–control study.

A pediatric hematology–oncology outpatient clinic at Fresno Children's Hospital.

Pediatric hematology–oncology clinic outpatients with CVCs at Fresno Children's Hospital between November 1994 and October 1997.

A case-patient was defined as any hematology–oncology outpatient with a CVC-associated BSI at Fresno Children's Hospital from November 1996 to October 1997 (study period) without a localizable infection. To identify case-patients, we reviewed Fresno Children's Hospital records for all hematology–oncology clinic patients, those with CVCs and those with CVCs and BSIs. Control-patients were randomly selected hematology–oncology outpatients with a CVC but no BSI during the study period. Case-patient and control-patient demographics, diagnoses, caretakers, catheter types, catheter care, and water exposure were compared.

Twenty-five case-patients had 42 CVC-associated BSIs during the study period. No significant increase in CVC-associated BSI rates occurred among pediatric hematology–oncology patients. However, there was a statistically significant increase in nonendogenous, gram-negative (eg, Pseudomonas species) BSIs during summer months (May–October) compared with the rest of the year. Case-patients and control-patients differed only in catheter type; case-patients were more likely than control-patients to have a transcutaneous CVC. Summertime recreational water exposures were similar and high in the two groups.

Hematology–oncology clinic patients with transcutaneous CVCs are at greater risk for CVC-associated BSI, particularly during the summer. Caretakers should be instructed on proper care of CVCs, particularly protection of CVCs during bathing and recreational summer water activities, to reduce the risk of nonendogenous, gram-negative BSIs.

To determine the incidence of nosocomial infections (NIs) and fever of unknown origin among adult hematology–oncology patients.

Prospective surveillance study.

The 18-bed hematology–oncology unit at the University Hospital Bonn, Bonn, Germany.

All hematology–oncology patients admitted during a total of 8 months in 1998 and 1999.

Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Rates of NI and fever of unknown origin were calculated for patient-days and patient-days at risk (ie, days with neutropenia of < 500/mm3 or leukopenia of < 1,000/mm3).

Of 116 patients hospitalized for a total of 4,002 days (172 admissions; mean length of stay, 25.2 days), 32 (27.6%) had a total of 44 documented NIs (19 bloodstream infections, 15 pneumonias, 7 urinary tract infections, and 3 others). In addition, 33 fevers of unknown origin were documented in 28 patients. No patient had thrush while receiving antifungal prophylaxis. The overall rates for NI and fever of unknown origin were 11.0 and 8.2 per 1,000 patient-days (25.3 and 15.4 per 1,000 patient-days at risk), respectively. The risks for NI and fever of unknown origin were significantly higher during neutropenic days, with 34 (77.3%) of the 44 NIs and 22 (66.7%) of the 33 fevers of unknown origin occurring during 1,345 patient-days at risk.

Prospective surveillance for NIs on hematology–oncology units should include fever of unknown origin as the single most common and clinically important entity. For a meaningful comparison of surveillance data for hematology–oncology patients, the reported infection rates should include rates based on days with neutropenia, for which days with leukopenia could serve as a surrogate marker under routine conditions.

Catheter-related phlebitis is a frequent problem in the clinical setting. Risk factors for catheter-related phlebitis were assessed at a single tertiary-care institution where no routine change policy for peripheral intravenous catheters is in place.

In a nonrandomized, observational trial, peripheral intravenous Teflon catheters were inserted in patients with a diagnosis of leukemia, lymphoma, solid tumor, acquired immunodeficiency syndrome, other serious infection, or autoimmune disorder. Underlying disease, age, white blood cell count at the time of insertion, physician placing the catheter, catheter bore, duration of cannulation, reason for removal of the catheter, and visual inspection of the insertion site were recorded.

Four hundred twelve catheters were inserted in 175 patients. The number of catheterizations per episode varied between 1 and 7. Three hundred sixty-four (88.3%) catheter placements were evaluable. The mean duration of cannulation was 4.2 days. The overall incidence of phlebitis was 12.9%. Catheters in leukopenic patients showed a longer duration of cannulation compared with catheters in nonleukopenic patients, but no difference regarding the phlebitis rate.

Findings in this study partly contrast with data reported in the literature. In particular, leukopenia, female gender, prolonged duration of cannulation, antibiotics, and choice of insertion site could not be shown to be risk factors.

The incidence of extended-spectrum β-lactamase (ESβL)–mediated resistance has increased markedly during the past decade. Risk factors for colonization with ESβL-producing Escherichia coli and Klebsiella species (ESβL-EK) remain unclear, as do methods to control their further emergence.

Case–control study.

Two hospitals within a large academic health system: a 725-bed academic tertiary-care medical center and a 344-bed urban community hospital.

Thirteen patients with ESβL-EK fecal colonization were compared with 46 randomly selected noncolonized controls.

Duration of hospitalization was the only independent risk factor for ESβL-EK colonization (odds ratio, 1.11; 95% confidence interval, 1.02 to 1.21). Of note, 8 (62%) of the patients had been admitted from another healthcare facility. In addition, there was evidence for dissemination of a single K. oxytoca clone. Finally, the prevalence of ESβL-EK colonization decreased from 7.9% to 5.7% following restriction of third-generation cephalosporins (P = .51).

ESβL-EK colonization was associated only with duration of hospitalization and there was no significant reduction following antimicrobial formulary interventions. The evidence for nosocomial spread and the high percentage of patients with ESβL-EK admitted from other sites suggest that greater emphasis must be placed on controlling the spread of such organisms within and between institutions.

To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism.

A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.

Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.

A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P < .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1; P = .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1; P=. 02).

Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions.

Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.

To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections.

Prospective observational study.

A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand.

All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study.

The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models.

There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter–related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter–related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95, 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95, 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively.

Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.