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In-Hospital Transfer Is a Risk Factor for Invasive Filamentous Fungal Infection among Hospitalized Patients with Hematological Malignancies: A Matched Case-Control Study

Published online by Cambridge University Press:  09 January 2015

Angèle Gayet-Ageron ,
Anne Iten ,
Christian van Delden ,
Natacha Farquet ,
Stavroula Masouridi-Levrat ,
Elodie Von Dach ,
Yves Chalandon  and
Didier Pittet
Angèle Gayet-Ageron
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Clinical Research Center & Division of Clinical Epidemiology, Department of Health and Community Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Anne Iten
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Christian van Delden
Affiliation:
Division of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Natacha Farquet
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Stavroula Masouridi-Levrat
Affiliation:
Division of Hematology,University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Elodie Von Dach
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Yves Chalandon
Affiliation:
Division of Hematology,University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet*
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Address correspondence to Professor Didier Pittet, MD, MS, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, 4 Rue Gabrielle-Perret-Gentil 1211 Geneva 14, Switzerland (didier.pittet@hcuge.ch).
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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.

CONCLUSION

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.

Infect Control Hosp Epidemiol 2014;00(0): 1–9

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 320 - 328
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

AGA and AI contributed equally to this manuscript.

Preliminary results from this study were presented at the 2nd International Conference on Prevention and Infection Control; June 25–28, 2013, Geneva, Switzerland, Poster 202 (June 20, 2013).

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