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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
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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

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