title: Healthcare-associated infection in hematopoietic stem cell transplantation patients: risk factors and impact on outcome.
abstract: OBJECTIVE
  The objective of this study was to analyze the incidence of and risk factors for healthcare-associated infections (HAI) among hematopoietic stem cell transplantation (HSCT) patients, and the impact of such infections on mortality during hospitalization.
  
  
  METHODS
  We conducted a 9-year (2001-2009) retrospective cohort study including patients submitted to HSCT at a reference center in São Paulo, Brazil. The incidence of HAI was calculated using days of neutropenia as the denominator. Data were analyzed using EpiInfo 3.5.1.
  
  
  RESULTS
  Over the 9-year period there were 429 neutropenic HSCT patients, with a total of 6816 days of neutropenia. Bloodstream infections (BSI) were the most frequent infection, presenting in 80 (18.6%) patients, with an incidence of 11.7 per 1000 days of neutropenia. Most bacteremia was due to Gram-negative bacteria: 43 (53.8%) cases were caused by Gram-negative species, while 33 (41.2%) were caused by Gram-positive species, and four (5%) by fungal species. Independent risk factors associated with HAI were prolonged neutropenia (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.04-1.10) and duration of fever (OR 1.20, 95% CI 1.12-1.30). Risk factors associated with death in multivariate analyses were age (OR 1.02, 95% CI 1.01-1.43), being submitted to an allogeneic transplant (OR 3.08, 95% CI 1.68-5.56), a microbiologically documented infection (OR 2.96, 95% CI 1.87-4.6), invasive aspergillosis disease (OR 2.21, 95% CI 1.1-4.3), and acute leukemias (OR 2.24, 95% CI 1.3-3.6).
  
  
  CONCLUSIONS
  BSI was the most frequent HAI, and there was a predominance of Gram-negative microorganisms. Independent risk factors associated with HAI were duration of neutropenia and fever, and the risk factors for a poor outcome were older age, type of transplant (allogeneic), the presence of a microbiologically documented infection, invasive aspergillosis, and acute leukemia. Further prospective studies with larger numbers of patients may confirm the role of these risk factors for a poor clinical outcome and death in this transplant population.
authors.affiliation: Departamento de Molestias Infecciosas, Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil. elisa-mendes@bol.com.br
authors.forename: Elisa Teixeira
authors.initials: ET
authors.lastname: Mendes
authors.forename: Frederico
authors.initials: F
authors.lastname: Dulley
authors.forename: Mariusa
authors.initials: M
authors.lastname: Basso
authors.forename: Marjorie Vieira
authors.initials: MV
authors.lastname: Batista
authors.forename: Fabio
authors.initials: F
authors.lastname: Coracin
authors.forename: Thais
authors.initials: T
authors.lastname: Guimarães
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Shikanai-Yasuda
authors.forename: Anna Sara
authors.initials: AS
authors.lastname: Levin
authors.forename: Silvia Figueiredo
authors.initials: SF
authors.lastname: Costa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology*; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000453:epidemiology; D016469:Fungemia / Q000453:epidemiology*; D018380:Hematopoietic Stem Cell Transplantation; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000453:epidemiology; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult