title: Impact of a change in protected environment on the occurrence of severe bacterial and fungal infections in children undergoing hematopoietic stem cell transplantation.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a procedure with a high infection risk. Strict isolation of patients is the rule to prevent such condition.
  
  
  OBJECTIVE
  We compared the occurrence of severe infections (bacteremia and invasive fungal infection, IFI) in children undergoing alloHSCT before and after the move to a new protected unit with decreases in isolation methods.
  
  
  METHODS
  The study was conducted over a 10-year period. Unit 1 (2002-2007) consisted of laminar airflow rooms where caregivers were required to wear a sterile outfit (gown, gloves, hat, and mask). Unit 2 (2008-2012) included spacious positive air pressure rooms with HEPA filters where only a clean gown and mask were required to be worn.
  
  
  RESULTS
  Two hundred eighty-six alloHSCTs were performed (144 in Unit 1 and 142 in Unit 2). We reported a total incidence of 4.78 infections/1000 hospital-days including 4.4 episodes of bacteremia and 0.38 episodes of IFI. There was no statistical difference in the incidence of infections: n = 4.98/1000 hospital-days in Unit 1 vs. n = 4.6/1000 in Unit 2 (P = 0.63).
  
  
  CONCLUSIONS
  The lack of difference in the occurrence of severe infection supports our decision to decrease unnecessary high protection in alloHSCT units to improve children's daily life.
authors.affiliation: Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France.
authors.forename: Clara
authors.initials: C
authors.lastname: Libbrecht
authors.affiliation: Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Goutagny
authors.affiliation: Pediatric Nephrology Unit, Women-Mother and Child Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.affiliation: Bacteriology Unit, Women-Mother and Child Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Ploton
authors.affiliation: Medical Mycology and Parasitology Unit, IP2M, Hospices Civils de Lyon, Lyon, France.|Malaria Research Unit, ICBMS, CNRS UMR 5246, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Bienvenu
authors.affiliation: Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bleyzac
authors.affiliation: Tissue and Cell Bank, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Mialou
authors.affiliation: Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Bertrand
authors.affiliation: Institute of Pediatric Hematology and Oncology, Hospices Civils de Lyon, Claude Bernard Lyon I University, Lyon, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Domenech
mesh_terms: D000293:Adolescent; D019072:Antibiotic Prophylaxis; D016470:Bacteremia / Q000209:etiology; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004780:Environment, Controlled; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous; D055815:Young Adult
keywords: allogeneic HSCT; infections; pediatrics; protected environment