Nosocomial infection in adult admissions with hematological malignancies originating from different lineages: a prospective observational study

PLoS One. 2014 Nov 21;9(11):e113506. doi: 10.1371/journal.pone.0113506. eCollection 2014.

Abstract

Background: Nosocomial infection (NI) causes prolonged hospital stays, increased healthcare costs, and higher mortality among patients with hematological malignancies (HM). However, few studies have compared the incidence of NI according to the HM lineage.

Objective: To compare the incidence of NI according to the type of HM lineage, and identify the risk factors for NI.

Methods: This prospective observational study monitored adult patients with HM admitted for >48 hours to the General Hospital of the People's Liberation Army during 2010-2013. Attack rates and incidences of NI were compared, and multivariable logistic regression was used to control for confounding effects.

Results: This study included 6,613 admissions from 1,922 patients. During these admissions, 1,023 acquired 1,136 NI episodes, with an attack rate of 15.47% and incidence of 9.6‰ (95% CI: 9.1-10.2). Higher rates and densities of NIs were observed among myeloid neoplasm (MN) admissions, compared to lymphoid neoplasm (LN) admissions (28.42% vs. 11.00%, P<0.001 and 11.4% vs. 8.4‰, P<0.001). NI attack rates in acute myeloid leukemia (AML) and myelodysplastic/myeloproliferative neoplasm (MDS/MPN) were higher than those in MDS (30.69% vs. 20.19%, P<0.001; 38.89% vs. 20.19%, P = 0.003). Attack rates in T/NK-cell neoplasm and B-cell neoplasm were higher than those in Hodgkin lymphoma (15.04% vs. 3.65%; 10.94% vs. 3.65%, P<0.001). Multivariable regression analysis indicated prolonged hospitalization, presence of central venous catheterization, neutropenia, current stem cell transplant, infection on admission, and old age were independently associated with higher NI incidence. After adjusting for these factors, MN admissions still had a higher risk of infection (odds ratio 1.34, 95% CI: 1.13-1.59, P<0.001).

Conclusion: Different NI attack rates were observed for HM from different lineages, with MN lineages having a higher attack rate and incidence than LN lineages. Special attention should be paid to MN admissions, especially AML and MDS/MPN admissions, to control NI incidence.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Cross Infection / epidemiology*
  • Female
  • Hematologic Neoplasms / complications*
  • Hematologic Neoplasms / microbiology*
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Myelodysplastic-Myeloproliferative Diseases / complications*
  • Myelodysplastic-Myeloproliferative Diseases / microbiology
  • Prospective Studies

Grants and funding

This work was supported by 1 National Natural Science Foundation of China (No. 30872155); 2 China Special Grant for the Prevention and Control of Infectious Diseases (No. 2013ZX10004 805 – 003, 2013ZX10004 217-002, 2009ZX10004-204); 3 The twelfth five year research foundation of Military Medical Sciences and Technology [the key program (AWS11L009) and the Special Grant for health protection (11BJZ01)]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.