Nosocomial infections in neutropenic cancer patients.

P. S. Carlisle, Rasim A. Gucalp, P. H. Wiernik

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

OBJECTIVE: Identification of overall and site-specific rates of nosocomial infection in neutropenic patients with cancer and associated pathogens. DESIGN: Cumulative continuous prospective surveillance over a 42-month period. Criteria and definitions of infection in neutropenic patients (absolute neutrophil counts < 1,000/mm3) were developed, and surveillance was carried out by a certified infection control nurse and a senior oncology research fellow. SETTING: A cancer research center with two designated oncology nursing units. PATIENTS: Neutropenic patients with hematological and solid malignancies undergoing high-dose chemotherapy with and without autologous bone marrow transplantation. All patients admitted to both of the units during the study period were surveyed. Those who developed neutropenia are included in this report. RESULTS: A total of 444 nosocomial infections were identified in 920 neutropenic patients during 9,582 days of neutropenia for an overall rate of 48.3 per 100 neutropenic patients, or 46.3 per 1,000 days at risk. The rate of bloodstream infection per 100 neutropenic patients was 13.5 (gram-positive, 9.2; gram-negative, 4.8; and Candida 1.2). Other site-specific rates were: urinary tract, 5.7; respiratory tract, 5.5; thrush, 6.6; skin, 3.4; and gastrointestinal tract, 3.4. Among 392 pathogens identified, there were 137 (35%) gram-positive cocci, 105 (27%) gram-negative rods, 70 (18%) Candida, 37 (9%) gram-positive rods, 22 (6%) viruses, and 15 (4%) Aspergillus. CONCLUSIONS: The rate of both overall and site-specific nosocomial infections in neutropenic patients is high. Neutropenia is a significant intrinsic risk factor that should be addressed in surveillance programs. Infection control and infectious diseases practitioners may need to modify techniques for surveillance, control, and management of infection in this population.

Original languageEnglish (US)
Pages (from-to)320-324
Number of pages5
JournalInfection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America
Volume14
Issue number6
StatePublished - Jun 1993

Fingerprint

Cross Infection
Neoplasms
Infection Control
Neutropenia
Candida
Gram-Positive Rods
Oncology Nursing
Oral Candidiasis
Gram-Positive Cocci
Intrinsic Factor
Autologous Transplantation
Hematologic Neoplasms
Aspergillus
Infection
Urinary Tract
Bone Marrow Transplantation
Research
Respiratory System
Communicable Diseases
Gastrointestinal Tract

ASJC Scopus subject areas

  • Immunology
  • Microbiology (medical)

Cite this

Nosocomial infections in neutropenic cancer patients. / Carlisle, P. S.; Gucalp, Rasim A.; Wiernik, P. H.

In: Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America, Vol. 14, No. 6, 06.1993, p. 320-324.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE: Identification of overall and site-specific rates of nosocomial infection in neutropenic patients with cancer and associated pathogens. DESIGN: Cumulative continuous prospective surveillance over a 42-month period. Criteria and definitions of infection in neutropenic patients (absolute neutrophil counts < 1,000/mm3) were developed, and surveillance was carried out by a certified infection control nurse and a senior oncology research fellow. SETTING: A cancer research center with two designated oncology nursing units. PATIENTS: Neutropenic patients with hematological and solid malignancies undergoing high-dose chemotherapy with and without autologous bone marrow transplantation. All patients admitted to both of the units during the study period were surveyed. Those who developed neutropenia are included in this report. RESULTS: A total of 444 nosocomial infections were identified in 920 neutropenic patients during 9,582 days of neutropenia for an overall rate of 48.3 per 100 neutropenic patients, or 46.3 per 1,000 days at risk. The rate of bloodstream infection per 100 neutropenic patients was 13.5 (gram-positive, 9.2; gram-negative, 4.8; and Candida 1.2). Other site-specific rates were: urinary tract, 5.7; respiratory tract, 5.5; thrush, 6.6; skin, 3.4; and gastrointestinal tract, 3.4. Among 392 pathogens identified, there were 137 (35{\%}) gram-positive cocci, 105 (27{\%}) gram-negative rods, 70 (18{\%}) Candida, 37 (9{\%}) gram-positive rods, 22 (6{\%}) viruses, and 15 (4{\%}) Aspergillus. CONCLUSIONS: The rate of both overall and site-specific nosocomial infections in neutropenic patients is high. Neutropenia is a significant intrinsic risk factor that should be addressed in surveillance programs. Infection control and infectious diseases practitioners may need to modify techniques for surveillance, control, and management of infection in this population.",
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