Incidence of, and risk factors for, nosocomial infections among hematopoietic stem cell transplantation recipients, with impact on procedure-related mortality.
OBJECTIVE
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.


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


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


METHODS
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.
Marena
C
C
Department of Hematology, Pediatric Hematology-Oncology, IRCCS San Matteo Hospital, Pavia, Italy.
Zecca
M
M
Carenini
M L
ML
Bruschi
A
A
Bassi
M L
ML
Olivieri
P
P
Azzaretti
S
S
Locatelli
F
F
D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology*; D002648:Child; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006757:Hospital Units / Q000706:statistics & numerical data; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009894:Opportunistic Infections / Q000097:blood / Q000453:epidemiology; D011159:Population Surveillance; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome