title: Nosocomial infection in adult admissions with hematological malignancies originating from different lineages: a prospective observational study.
abstract: BACKGROUND
  Nosocomial infection (NI) causes prolonged hospital stays, increased healthcare costs, and higher mortality among patients with hematological malignancies (HM). However, few studies have compared the incidence of NI according to the HM lineage.
  
  
  OBJECTIVE
  To compare the incidence of NI according to the type of HM lineage, and identify the risk factors for NI.
  
  
  METHODS
  This prospective observational study monitored adult patients with HM admitted for >48 hours to the General Hospital of the People's Liberation Army during 2010-2013. Attack rates and incidences of NI were compared, and multivariable logistic regression was used to control for confounding effects.
  
  
  RESULTS
  This study included 6,613 admissions from 1,922 patients. During these admissions, 1,023 acquired 1,136 NI episodes, with an attack rate of 15.47% and incidence of 9.6‰ (95% CI: 9.1-10.2). Higher rates and densities of NIs were observed among myeloid neoplasm (MN) admissions, compared to lymphoid neoplasm (LN) admissions (28.42% vs. 11.00%, P<0.001 and 11.4% vs. 8.4‰, P<0.001). NI attack rates in acute myeloid leukemia (AML) and myelodysplastic/myeloproliferative neoplasm (MDS/MPN) were higher than those in MDS (30.69% vs. 20.19%, P<0.001; 38.89% vs. 20.19%, P = 0.003). Attack rates in T/NK-cell neoplasm and B-cell neoplasm were higher than those in Hodgkin lymphoma (15.04% vs. 3.65%; 10.94% vs. 3.65%, P<0.001). Multivariable regression analysis indicated prolonged hospitalization, presence of central venous catheterization, neutropenia, current stem cell transplant, infection on admission, and old age were independently associated with higher NI incidence. After adjusting for these factors, MN admissions still had a higher risk of infection (odds ratio 1.34, 95% CI: 1.13-1.59, P<0.001).
  
  
  CONCLUSIONS
  Different NI attack rates were observed for HM from different lineages, with MN lineages having a higher attack rate and incidence than LN lineages. Special attention should be paid to MN admissions, especially AML and MDS/MPN admissions, to control NI incidence.
authors.affiliation: Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China; Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Respiratory Medicine, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jin
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China.
authors.forename: Yubin
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Department of Hematology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Digestive Medicine, the Second Affiliated Hospital of Dalian Medical University, Dalian, China.
authors.forename: Mingmei
authors.initials: M
authors.lastname: Du
authors.affiliation: Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jijiang
authors.initials: J
authors.lastname: Suo
authors.affiliation: Department of Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yunxi
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D003428:Cross Infection / Q000453:epidemiology*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000382:microbiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D054437:Myelodysplastic-Myeloproliferative Diseases / Q000150:complications* / Q000382:microbiology; D011446:Prospective Studies