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Surveillance for Nosocomial Infections and Fever of Unknown Origin Among Adult Hematology–Oncology Patients

Published online by Cambridge University Press:  02 January 2015

Steffen Engelhart ,
Axel Glasmacher ,
Martin Exner  and
Michael H. Kramer
Steffen Engelhart*
Affiliation:
Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
Axel Glasmacher
Affiliation:
Department of Internal Medicine I, University of Bonn, Bonn, Germany
Martin Exner
Affiliation:
Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
Michael H. Kramer
Affiliation:
Institute of Hygiene and Public Health, University of Bonn, Bonn, Germany
*
Institute of Hygiene and Public Health, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
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Abstract

Objective:

To determine the incidence of nosocomial infections (NIs) and fever of unknown origin among adult hematology–oncology patients.

Design:

Prospective surveillance study.

Setting:

The 18-bed hematology–oncology unit at the University Hospital Bonn, Bonn, Germany.

Patients:

All hematology–oncology patients admitted during a total of 8 months in 1998 and 1999.

Methods:

Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance system. Rates of NI and fever of unknown origin were calculated for patient-days and patient-days at risk (ie, days with neutropenia of < 500/mm3 or leukopenia of < 1,000/mm3).

Results:

Of 116 patients hospitalized for a total of 4,002 days (172 admissions; mean length of stay, 25.2 days), 32 (27.6%) had a total of 44 documented NIs (19 bloodstream infections, 15 pneumonias, 7 urinary tract infections, and 3 others). In addition, 33 fevers of unknown origin were documented in 28 patients. No patient had thrush while receiving antifungal prophylaxis. The overall rates for NI and fever of unknown origin were 11.0 and 8.2 per 1,000 patient-days (25.3 and 15.4 per 1,000 patient-days at risk), respectively. The risks for NI and fever of unknown origin were significantly higher during neutropenic days, with 34 (77.3%) of the 44 NIs and 22 (66.7%) of the 33 fevers of unknown origin occurring during 1,345 patient-days at risk.

Conclusions:

Prospective surveillance for NIs on hematology–oncology units should include fever of unknown origin as the single most common and clinically important entity. For a meaningful comparison of surveillance data for hematology–oncology patients, the reported infection rates should include rates based on days with neutropenia, for which days with leukopenia could serve as a surrogate marker under routine conditions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 5 , May 2002 , pp. 244 - 248
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Hughes, WT, Armstrong, D, Bodey, GP, et al. 1997 guidelines for the use of antimicrobial agents in neutropenic patients with unexplained fever. Clin Infect Dis 1997;25:551–573.Google Scholar
2.Carlisle, PS, Gucalp, R, Wiernik, PH. Nosocomial infections in neutropenic cancer patients. Infect Control Hosp Epidemiol 1993;14:320–324.CrossRefGoogle ScholarPubMed
3.Rotstein, C, Cummings, KM, Nicolaou, AL, Lucey, J, Fitzpatrick, J. Nosocomial infection rates at an oncology center. Infect Control Hosp Epidemiol 1988;9:13–19.CrossRefGoogle ScholarPubMed
4.Velasco, E, Santos Thuler, IX, de St Martins, CA, de Castro Dias, LM, Goncalves, VM. Nosocomial infections in an oncology intensive care unit. Am J Infect Control 1997;26:458–462.Google Scholar
5.Emori, TG, Culver, DH, Horan, TC. National Nosocomial Infections Surveillance (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
6.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
7.Durack, DT, Street, AC. Fever of unknown origin: reexamined and redefined. Curr Clin Top Infect Dis 1991;11:35–51.Google Scholar
8.Hughes, WT, Flynn, PM, Williams, BG. Nosocomial infection in patients with neoplastic diseases. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control, 2nd ed. Baltimore, MD: Williams & Wilkins; 1999:767–780.Google Scholar
9.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522–533.Google Scholar
10.Link, H, Blumenstengel, K, Böhme, A, et al. Antimikrobielle Therapie von unerklärtem Fieber bei Neutropenie: Standardempfehlungen der Arbeitsgemeinschaft Infektiologie in der Hämatologie und Onkologie der Deutschen Gesellschaft für Hämatologie und Onkologie. Dtsch Med Wochenschr 1999;124(suppl 1):S3–S8.Google Scholar
11.Pizzo, PA. Management of fever in patients with cancer and chemotherapy induced neutropenia. N Engl J Med 1993;328:1323–1332.Google Scholar
12.National Nosocomial Infections Surveillance (NNIS) System. Nosocomial infection rates for interhospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 1991;12:609–621.Google Scholar
13.Simon, A, Fleischhack, G, Hasan, C, Bode, U, Engelhart, S, Kramer, MH. Surveillance for nosocomial and central line-related infections among pediatric hematology–oncology patients. Infect Control Hosp Epidemiol 2000;21:592–596.Google Scholar
14.Hirschmann, JV. Fever of unknown origin in adults. Clin Infect Dis 1997;24:291–300.CrossRefGoogle ScholarPubMed
15.Klasterski, J, Weerts, D, Hensgens, C, Debusscher, L. Fever of unexplained origin in patients with cancer. Eur J Cancer 1973;9:649–656.Google Scholar
16.Luft, FC, Rissing, JP, White, A, Brooks, GF. Infections or neoplasm as causes of prolonged fever in cancer patients. Am J Med Sci 1976;272:65–74.CrossRefGoogle ScholarPubMed
17.Barrios, NJ, Tebbi, CK, Freeman, AI, Brecher, ML. Toxicity of high dose Ara-C in children and adolescents. Cancer 1987;60:165–169.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
18.Perfect, JR, Lindsay, MH, Drew, RH. Adverse drug reactions to systemic antifungals: prevention and management. Drug Saf 1992;7:323–363.Google Scholar
19.Rubio, M, Palau, L, Vivas, JRet al. Predominance of gram-positive microorganisms as a cause of septicemia in patients with hematological malignancies. Infect Control Hosp Epidemiol 1994;15:101–104.Google Scholar
20.Loo, VG, Bertrand, C, Dixon, C, et al. Control of construction-associated nosocomial aspergillosis in an antiquated hematology unit. Infect Control Hosp Epidemiol 1996;17:360–364.Google Scholar