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Post-Transplant Complications

Outbreaks of infectious diseases in stem cell transplant units: a silent cause of death for patients and transplant programmes

Bone Marrow Transplantation volume 33, pages 519–529 (2004)Cite this article

Summary:

Following the closure of the National Blood and Bone Marrow Transplant Unit in Dublin, because of an outbreak of vancomycin-resistant enterococcal infection, a survey was carried out by the EBMT to investigate the occurrence of outbreaks of infection in SCT units and the impact on patient morbidity, mortality and the administration of the transplant programme over a 10-year period from 1991 to 2001. A total of 13 centres reported 23 outbreaks of infection involving 231 patients: 10 bacterial, eight viral and five fungal outbreaks were reported and 56 deaths were attributed to infection. All fungal and bacterial deaths and the majority of viral deaths occurred in allograft recipients. In all outbreaks, the infection was reported to be hospital acquired and in all the viral, and half the bacterial infections, cross-infection was a major factor. All viral, four of 10 bacterial and three of five fungal outbreaks occurred in HEPA filtered rooms. A total of 12 SCT units reported a partial or total closure. The introduction of mandatory quality management systems such as JACIE should result in a change in attitude to ‘incident reporting’ and together with future surveys should reduce the incidence of infectious outbreaks in SCT units.

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Acknowledgements

We thank the following for completing the questionnaire and for providing data: P Browne, St James's Hospital, Dublin, Ireland; JL Byrne, Nottingham City Hospital, Nottingham, UK; C Cordonnier, Hopital Henri Mondor, Paris, France; A Gratwohl, Kantonsspital, Basel, Switzerland; P Ljungman, Huddinge University Hospital, Huddinge, Sweden; S Mackinnon, University College Hospital, London, UK; E Olavarria, Imperial College School of Medicine, London, UK; P Ribaud, Hopital Saint-Louis, Paris, France; M Rovira, Hospital Clinic, Barcelona, Spain; P Shaw, The New Children's Hospital, Sydney, Australia; S Sica, Universita Cattolica, S Cuore, Rome, Italy; P Trabasso, Cicade Universitaria Zeferino Vaz, Sao Paolo, Brazil; MT Van Lint, Ospedale San Martino, Genoa, Italy; L Volin, Helsinki University Central PO, Helsinki, Finland; and K Ward, Windeyer Building, London, UK. We also thank the Department of Microbiology and Infection Control in St James's Hospital, Dublin for the detailed information on the VRE outbreak in Dublin. We also thank the PHLS, Central Public Health Laboratories, Colindale, for carrying out the molecular typing of enterococci.

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Authors and Affiliations

  1. Department of Haematology, Durkan Leukaemia Research Laboratories, Trinity Centre, St James's Hospital, Dublin, Ireland

    S McCann, J L Byrne, M Rovira, P Shaw, P Ribaud, S Sica, L Volin, E Olavarria, S Mackinnon, P Trabasso, M T VanLint, P Ljungman, K Ward, P Browne, A Gratwohl, A F Widmer & C Cordonnier

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Correspondence to S McCann.

Appendices

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McCann, S., Byrne, J., 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 33, 519–529 (2004). https://doi.org/10.1038/sj.bmt.1704380

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