Hostname: page-component-84b7d79bbc-x5cpj Total loading time: 0 Render date: 2024-07-26T19:52:16.998Z Has data issue: false hasContentIssue false
  • English
  • Français

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).
Get access Rights & Permissions [Opens in a new window]

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 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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).

References

REFERENCES

1.Lin, SJ, Schranz, J, Teutsch, SM. Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001;32:358–366.CrossRefGoogle ScholarPubMed
2.Gavalda, J, Len, O, San Juan, R, et al. Risk factors for invasive aspergillosis in solid-organ transplant recipients: a case-control study. Clin Infect Dis 2005;41:52–59.CrossRefGoogle ScholarPubMed
3.Michallet, M, Ito, JI. Approaches to the management of invasive fungal infections in hematologic malignancy and hematopoietic cell transplantation. J Clin Oncol 2009;27:3398–3409.CrossRefGoogle Scholar
4.Marr, KA, Carter, RA, Crippa, F, Wald, A, Corey, L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis 2002;34:909–917.CrossRefGoogle ScholarPubMed
5.McCann, S, Byrne, JL, Rovira, M, et al. Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes. Bone Marrow Transplant 2004;33:519–529.CrossRefGoogle ScholarPubMed
6.Chang, CC, Athan, E, Morrissey, CO, Slavin, MA. Preventing invasive fungal infection during hospital building works. Intern Med J 2008;38:538–541.CrossRefGoogle ScholarPubMed
7.Vonberg, RP, Gastmeier, P. Nosocomial aspergillosis in outbreak settings. J Hosp Infect 2006;63:246–254.CrossRefGoogle ScholarPubMed
8.Kaiser, L, Huguenin, T, Lew, PD, Chapuis, B, Pittet, D. Invasive aspergillosis. Clinical features of 35 proven cases at a single institution. Medicine (Baltimore) 1998;77:188–194.CrossRefGoogle Scholar
9.Pittet, D, Huguenin, T, Dharan, S, et al. Unusual cause of lethal pulmonary aspergillosis in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996;154:541–544.CrossRefGoogle ScholarPubMed
10.Eggimann, P, Chevrolet, JC, Starobinski, M, et al. Primary invasive aspergillosis of the digestive tract: report of two cases and review of the literature. Infection 2006;34:333–388.CrossRefGoogle ScholarPubMed
11.De Pauw, B, Walsh, TJ, Donnelly, JP, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008;46:1813–1821.CrossRefGoogle Scholar
12.Berthelot, P, Loulergue, P, Raberin, H, et al. Efficacy of environmental measures to decrease the risk of hospital-acquired aspergillosis in patients hospitalised in haematology wards. Clin Microbiol Infect 2006;12:738–744.CrossRefGoogle ScholarPubMed
13.Chang, CC, Cheng, AC, Devitt, B, et al. Successful control of an outbreak of invasive aspergillosis in a regional haematology unit during hospital construction works. J Hosp Infect 2008;69:33–38.CrossRefGoogle Scholar
14.Sehulster, L, Chinn, RY. Guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). MMWR Recomm Rep 2003;52:1–42.Google ScholarPubMed
15.Hennessy, S, Bilker, WB, Berlin, JA, Strom, BL. Factors influencing the optimal control-to-case ratio in matched case-control studies. Am J Epidemiol 1999;149:195–197.CrossRefGoogle ScholarPubMed
16.Courvoisier, DS, Combescure, C, Agoritsas, T, Gayet-Ageron, A, Perneger, TV. Performance of logistic regression modeling: beyond the number of events per variable, the role of data structure. J Clin Epidemiol 2011;64:993–1000.CrossRefGoogle ScholarPubMed
17.Mahieu, LM, De Dooy, JJ, Van Laer, FA, Jansens, H, Ieven, MM. A prospective study on factors influencing aspergillus spore load in the air during renovation works in a neonatal intensive care unit. J Hosp Infect 2000;45:191–197.CrossRefGoogle Scholar
18.Raviv, Y, Kramer, MR, Amital, A, Rubinovitch, B, Bishara, J, Shitrit, D. Outbreak of aspergillosis infections among lung transplant recipients. Transpl Int 2007;20:135–140.CrossRefGoogle ScholarPubMed
19.Anderson, K, Morris, G, Kennedy, H, et al. Aspergillosis in immunocompromised paediatric patients: associations with building hygiene, design, and indoor air. Thorax 1996;51:256–261.CrossRefGoogle ScholarPubMed
20.Benet, T, Nicolle, MC, Thiebaut, A, et al. Reduction of invasive aspergillosis incidence among immunocompromised patients after control of environmental exposure. Clin Infect Dis 2007;45:682–686.CrossRefGoogle ScholarPubMed
21.Pelaez, T, Munoz, P, Guinea, J, et al. Outbreak of invasive aspergillosis after major heart surgery caused by spores in the air of the intensive care unit. Clin Infect Dis 2012;54:e24–e31.CrossRefGoogle ScholarPubMed
22.Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients. MMWR Recomm Rep 2000;49:1–125.Google Scholar
23.VandenBergh, MF, Verweij, PE, Voss, A. Epidemiology of nosocomial fungal infections: invasive aspergillosis and the environment. Diagn Microbiol Infect Dis 1999;34:221–227.CrossRefGoogle ScholarPubMed
24.Bouza, E, Pelaez, T, Perez-Molina, J, et al. Demolition of a hospital building by controlled explosion: the impact on filamentous fungal load in internal and external air. J Hosp Infect 2002;52:234–242.CrossRefGoogle ScholarPubMed
25.Iwen, PC, Davis, JC, Reed, EC, Winfield, BA, Hinrichs, SH. Airborne fungal spore monitoring in a protective environment during hospital construction, and correlation with an outbreak of invasive aspergillosis. Infect Control Hosp Epidemiol 1994;15:303–306.CrossRefGoogle Scholar
26.Pecoul, D, Munteanu, M, Iten, A, Pittet, D. Which preventive measures are taken for immunocompromised patients during their transport outside the ward? In: Program and abstracts of the 1stInternational Conference on Prevention and Infection Control (ICPIC) June 29–July 2 2011; Geneva, Switzerland. Abstract 383.Google Scholar
27.Weber, SF, Peacock, JE Jr., Do, KA, Cruz, JM, Powell, BL, Capizzi, RL. Interaction of granulocytopenia and construction activity as risk factors for nosocomial invasive filamentous fungal disease in patients with hematologic disorders. Infect Control Hosp Epidemiol 1990;11:235–242.CrossRefGoogle ScholarPubMed
28.Panackal, AA, Dahlman, A, Keil, KT, et al. Outbreak of invasive aspergillosis among renal transplant recipients. Transplantation 2003;75:1050–1053.CrossRefGoogle ScholarPubMed