Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation

doi:doi:10.1038/sj.bmt.1703920

Bone Marrow Transplantation (2003) 31, 795–801. doi:10.1038/sj.bmt.1703920

Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation

M Dettenkofer^1,4, W Ebner^1,4, H Bertz², R Babikir^1,4, J Finke², U Frank^1,4, H Rüden^3,4 and F D Daschner^1,4

¹Institute of Environmental Medicine and Hospital Epidemiology, University Hospital of Freiburg, Germany
²Department of Internal Medicine I (Haematology/Oncology), University Hospital of Freiburg, Germany
³Institute of Hygiene Free University of Berlin, Germany
⁴German National Reference Centre for Hospital Hygiene, Germany^*

Correspondence: Dr M Dettenkofer, Institute of Environmental Medicine and Hospital Epidemiology, Hugstetterstr. 55, D-79106 Freiburg, Germany

Received 4 March 2002; Accepted 15 December 2002.

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Abstract

To identify overall and site-specific rates of nosocomial infections (NIs) during the neutropenic, as compared to the non-neutropenic stage of treatment in adult recipients of allogeneic and autologous bone marrow transplantation (BMT) and peripheral blood stem-cell transplantation (PBSCT), a prospective, 54-month study was started at the Haematological Stem Cell Transplantation Unit of the University Hospital of Freiburg, Germany. NI types were identified using modified CDC definitions. A total of 351 patients (14 256 in-patient days, 5026 neutropenic days) were investigated (316/90% allogeneic, 35/10% autologous; BMT: 119 patients, PBSCT: 234 patients). The mean length of neutropenia was 14.3 days (range: 0–66). Antimicrobial prophylaxis for allogeneic transplantation consisted of ciprofloxacin, trimethoprim/sulpha-methoxazole, fluconazole, and metronidazole. In total, 239 NIs were identified in 169 patients (48.1%), and of these 171 (71.5%) occurred during neutropenia (34.0 NIs per 1000 days at risk). The main pathogens were coagulase-negative staphylococci (36.3%), Clostridium difficile (20.4%), and enterococci (10.0%). Site-specific incidence densities during neutropenia vs non-neutropenia were: 13.9 vs 1.6 bloodstream infections (all central line-associated), 11.9 vs 1.8 pneumonias, 3.0 vs 2.9 gastroenteritis, and 1.6 vs 0.3 urinary tract infections. The greatest number of NI in BMT and PBSCT recipients is acquired during neutropenia, and multicentre surveillance programmes should focus on this.