title: In-hospital transfer is a risk factor for invasive filamentous fungal infection among hospitalized patients with hematological malignancies: a matched case-control study.
abstract: OBJECTIVE
  Immunocompromised patients now benefit from a longer life expectancy due to advanced medical techniques, but they are also weakened by aggressive treatment approaches and are at high risk for invasive fungal disease. We determined risk factors associated with an outbreak of invasive filamentous fungal infection (IFFI) among hospitalized hemato-oncological patients.
  
  
  METHODS
  A retrospective, matched, case-control study was conducted between January 1, 2009, and April 31, 2011, including 29 cases (6 proven, 8 probable, and 15 possible) of IFFI and 102 matched control patients hospitalized during the same time period. Control patients were identified from the hospital electronic database. Conditional logistic regression was performed to identify independent risk factors for IFFI.
  
  
  RESULTS
  Overall mortality associated with IFFI was 20.7% (8.0%-39.7%). Myelodysplastic syndrome was associated with a higher risk for IFFI compared to chronic hematological malignancies. After adjustment for major risk factors and confounders, >5 patient transfers outside the protected environment of the hematology ward increased the IFFI risk by 6.1-fold. The risk increased by 6.7-fold when transfers were performed during neutropenia.
  
  
  CONCLUSIONS
  This IFFI outbreak was characterized by a strong association with exposure to the unprotected environment outside the hematology ward during patient transfer. The independent associations of a high number of transfers with the presence of neutropenia suggest that affected patients were probably not sufficiently protected during transport in the corridors. Our study highlights that a heightened awareness of the need for preventive measures during the entire care process of at-risk patients should be promoted among healthcare workers.
authors.affiliation: 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Angèle
authors.initials: A
authors.lastname: Gayet-Ageron
authors.affiliation: 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Anne
authors.initials: A
authors.lastname: Iten
authors.affiliation: 3Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: van Delden
authors.affiliation: 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Natacha
authors.initials: N
authors.lastname: Farquet
authors.affiliation: 4Division of Hematology,University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Stavroula
authors.initials: S
authors.lastname: Masouridi-Levrat
authors.affiliation: 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Elodie
authors.initials: E
authors.lastname: Von Dach
authors.affiliation: 4Division of Hematology,University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Yves
authors.initials: Y
authors.lastname: Chalandon
authors.affiliation: 1Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000164:Acremonium / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060487:Alternariosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D001228:Aspergillosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D010360:Patient Transfer; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland