Incidence of Hospital-Acquired Pneumonia, Bacteraemia and Urinary Tract Infections in Patients with Haematological Malignancies, 2004–2010: A Surveillance-Based Study

Catherine Huoi,Philippe Vanhems,Mauricette Michallet,Thomas Bénet,Marie-Christine Nicolle,Vishnu Chaturvedi

doi:10.1371/journal.pone.0058121

Catherine Huoi, Philippe Vanhems + Show 4 more

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https://doi.org/10.1371/journal.pone.0058121

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Abstract

ObjectiveThis study charted incidence trends of hospital-acquired (HA) pneumonia, bacteraemia and urinary tract infections (UTI) in a haematology department.MethodsProspective surveillance of hospital-acquired infections (HAI) was undertaken in a 42-bed haematology department of a university hospital. All patients hospitalized ≥48 hours between 1st January 2004 and 31st December 2010 were included. Definitions of HAI were based on a standardized protocol. The incidence was the number of events per 1000 patient-days at risk; only the first HAI was counted. Multivariate Poisson regression was fitted to assess temporal trends.ResultsAmong 3 355 patients (58 063 patient-days at risk) included, 1 055 (31%) had HAI. The incidence of HA pneumonia, HA bacteraemia and HA UTI was respectively 3.3, 12.0 and 2.9 per 1000 patient-days at risk. HA bacteraemia incidence increased by 11% (95% confidence interval: +6%, +15%, P<0.001) per year, independently of neutropenia, central venous catheterization (CVC) and haematological disease. The incidences of HA pneumonia and HA UTI were stable. The most frequently isolated pathogens were Aspergillus spp. (59.2%) for pneumonia, coagulase-negative Staphylococcus (44.2%) for bacteraemia and enterobacteria (60%) for UTI.ConclusionThe incidence of bacteraemia increased, indicating that factors other than CVC exposure, including chemotherapy with its impact on the immune system, could explain this trend. Further analytic studies are needed to explore the factors that could explain this trend.

Highlights

Patients with haematological malignancies are at high risk of hospital-acquired infections (HAI) because the severity of their underlying illness often requires aggressive treatment: chemotherapy, bone marrow or peripheral blood stem cell transplantation
Over the past few decades, major progress has been made in the curative treatment of haematological malignancies which has resulted in reduced overall mortality [9,10,11,12], and longer neutropenia and higher risk of infectious complications [13,14]
Setting Prospective surveillance of HA pneumonia, bacteraemia and urinary tract infections (UTI) was implemented at the 42-bed haematology department of Edouard Herriot University Hospital in Lyon, France, between 1st January 2004 and 31st December 2010

Summary

Introduction

Patients with haematological malignancies are at high risk of hospital-acquired infections (HAI) because the severity of their underlying illness often requires aggressive treatment: chemotherapy, bone marrow or peripheral blood stem cell transplantation. This could lead to severe and prolonged immunosuppression, increasing the risk of infection and possibly worsening the prognosis [1,2]. To the best of our knowledge, trends in HAI incidence in the general population of adult patients with haematological malignancies have been poorly investigated The objectives of this prospective surveillance were: 1) to track trends in the incidence of HA pneumonia, bacteraemia and urinary tract infections (UTI) in patients with haematological malignancies; 2) to identify the common etiological pathogens for these infections

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Conclusion