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

2002 ◽  
Vol 23 (5) ◽  
pp. 244-248 ◽  
Author(s):  
Steffen Engelhart ◽  
Axel Glasmacher ◽  
Martin Exner ◽  
Michael H. Kramer
Keyword(s):  
At Risk ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Fever Of Unknown Origin ◽  
Surrogate Marker ◽  
Unknown Origin ◽  
University Hospital ◽  
Prospective Surveillance ◽  
Oncology Patients ◽  
Tract Infections

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.

Surveillance for Nosocomial and Central Line-Related Infections Among Pediatric Hematology-Oncology Patients

2000 ◽  
Vol 21 (9) ◽  
pp. 592-596 ◽  
Author(s):  
Arne Simon ◽  
Gudrun Fleischhack ◽  
Carola Hasan ◽  
Udo Bode ◽  
Steffen Engelhart ◽  
...  
Keyword(s):  
Infection Control ◽  
Home Care ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Severe Neutropenia ◽  
Prospective Surveillance ◽  
Surveillance Period ◽  
Oncology Patients ◽  
Pediatric Hematology ◽  
Significant Difference

AbstractObjective:To determine the incidence of all nosocomial infections (NIs) in pediatric hematology-oncology patients, as well as central venous access device (CVAD)-associated infections acquired during home care.Design:Prospective surveillance study.Setting:The Pediatric Hematology and Oncology Department at the University Hospital Bonn.Patients:All patients admitted from January through October 1998 (surveillance period).Methods:Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System.Results:A total of 143 patients were hospitalized for 3,701 days (776 admissions) during the surveillance period. Of the 40 NIs detected, 26 were CVAD-related, with 21 bloodstream infections (BSIs) and 5 local infections. Four were Clostridium difficile-associated diarrheal illnesses, 3 were pneumonias, and 7 were other infections. The incidence of NIs was 10.8 per 1,000 patient-days (5.2 NIs/100 admissions). The overall CVAD-related BSI rate was 7.4 per 1,000 utilization days, without a significant difference between implanted infusion ports and tunneled catheters. In addition, 7 CVAD-related infections occurred during home care. All 8 BSIs associated with tunneled catheters and 13 (76%) of the 17 BSIs associated with ports were acquired nosocomially. For inpatients and outpatients combined, the exit sites of tunneled catheters were more likely to become locally infected than were the needle entry sites of ports (relative risk, 8.0; P=.007). In 30 (75%) of the 40 NIs, the affected patients had severe neutropenia (<500/mm3) at the time of infection.Conclusions:Most NIs in the pediatric hematology-oncology patients were associated with CVAD devices. Although many infections in this high-risk population may not be preventable through infection control measures, the careful evaluation of specific infection rates permits the identification of risk factors that may be targeted by infection control programs. Prospective surveillance for NIs on pediatric oncology units is an indispensable tool for this internal quality control.

scholarly journals Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study

2022 ◽  
Vol 11 (2) ◽  
pp. 386
Author(s):  
Kim-Heang Ly ◽  
Nathalie Costedoat-Chalumeau ◽  
Eric Liozon ◽  
Stéphanie Dumonteil ◽  
Jean-Pierre Ducroix ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diagnostic Value ◽  
University Hospital ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Multicentre Prospective Study

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

scholarly journals Place of the 18F-FDG-PET/CT in the Diagnostic Workup in Patients with Classical Fever of Unknown Origin (FUO)

2021 ◽  
Vol 10 (17) ◽  
pp. 3831
Author(s):  
Simon Letertre ◽  
Pierre Fesler ◽  
Laetitia Zerkowski ◽  
Marie-Christine Picot ◽  
Jean Ribstein ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Real Life ◽  
Unknown Origin ◽  
Diagnostic Workup ◽  
University Hospital ◽  
True Positive ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Objective: To explore the diagnostic contribution of the 18F-FDG-PET/CT in a population of patients with classical fever of unknown origin (FUO), to pinpoint its place in the diagnostic decision tree in a real-life setting, and to identify the factors associated with a diagnostic 18F-FDG-PET/CT. Method: All adult patients (aged ≥ 18 years) with a diagnosis of classical FUO who underwent an 18F-FDG-PET/CT in the University Hospital of Montpellier (France) between April 2012 and December 2017 were included. True positive 18F-FDG-PET/CT, which evidenced a specific disease causing FUO, were considered to be contributive. Results: Forty-four patients with FUO have been included (20 males, 24 females; mean age 57.5 ± 17.1 years). Diagnoses were obtained in 31 patients (70.5%), of whom 17 (38.6%) had non-infectious inflammatory diseases, 9 had infections (20.5%), and 3 had malignancies (6.8%). 18F-FDG-PET/CT was helpful for making a final diagnosis (true positive) in 43.6% of all patients. Sensitivity and specificity levels were 85% and 37%, respectively. A total of 135 investigations were performed before 18F-FDG-PET/CT, mostly CT scans (93.2%) and echocardiography (59.1%), and 108 after 18F-FDG-PET/CT, mostly biopsies (including the biopsy of a temporal artery) (25%) and MRIs (34%). In multivariate analysis, the hemoglobin level was significantly associated with a helpful 18F-FDG-PET/CT (p = 0.019, OR 0.41; 95% CI (0.20–0.87)), while the CRP level was not associated with a contributive 18F-FDG-PET/CT. Conclusion: 18F-FDG-PET/CT may be proposed as a routine initial non-invasive procedure in the diagnostic workup of FUO, especially in anemic patients who could be more likely to benefit from 18F-FDG-PET/CT.

Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study

2010 ◽  
Vol 7 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Youssef A. Al-Tonbary ◽  
Othman E. Soliman ◽  
Mohammed M. Sarhan ◽  
Moustafa A. Hegazi ◽  
Rasha A. El-Ashry ◽  
...  
Keyword(s):  
Nosocomial Infections ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Pediatric Hematology ◽  
Oncology Unit

scholarly journals Diagnostic Use of Serum Ferritin Levels to Differentiate Infectious and Noninfectious Diseases in Patients with Fever of Unknown Origin

2013 ◽  
Vol 34 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Seong Eun Kim ◽  
Uh Jin Kim ◽  
Mi Ok Jang ◽  
Seung Ji Kang ◽  
Hee Chang Jang ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Serum Ferritin ◽  
Fever Of Unknown Origin ◽  
Inflammatory Diseases ◽  
Unknown Origin ◽  
University Hospital ◽  
Disease Group ◽  
Hematologic Disease ◽  
Hematologic Diseases

INTRODUCTION: In this study, we determined whether serum ferritin levels could be used to differentiate between fever of unknown origin (FUO) caused by infectious and noninfectious diseases.METHODS: FUO patients were hospitalized at Chonnam National University Hospital between January, 2005 and December, 2011. According to the final diagnoses, five causes were identified, including infectious diseases, hematologic diseases, noninfectious inflammatory diseases, miscellaneous and undiagnosed.RESULTS: Of the 77 patients, 11 were caused by infectious diseases, 13 by hematologic diseases, 20 by noninfectious inflammatory diseases, 8 by miscellaneous diseases, and 25 were undiagnosed. The median serum ferritin levels in infectious diseases was lower than those in hematologic diseases and (median (interquartile range) of 282.4 (149.0–951.8) ng/mL for the infectious disease group, 1818.2 (485.4–4789.5) ng/mL for the hematologic disease group, and 563.7 (399.6–1927.2) ng/mL for the noninfectious inflammatory disease group,p= 0.048, Kruskal–Wallis test). By comparison using the Mann–Whitney test, statistically significant differences were found only between the infectious disease and hematologic disease groups (p= 0.049) and between the infectious disease and groups (p= 0.04).CONCLUSION: An optimal cutoff value of serum ferritin levels to predict FUO caused by a noninfectious disease (hematologic diseases, noninfectious inflammatory diseases) was established as 561 ng/mL.

Rationale and Methods for a Statewide, Prospective Surveillance System for the Identification and Prevention of Nosocomial Infections

1981 ◽  
Vol 3 (4) ◽  
pp. 683-700 ◽  
Author(s):  
I. B. Tager ◽  
M. B. Ginsberg ◽  
E. Simchen ◽  
L. Miao ◽  
K. Holbrook ◽  
...  
Keyword(s):  
Nosocomial Infections ◽  
Surveillance System ◽  
Prospective Surveillance

scholarly journals Nosocomial infections in the Intesive care unit, University hospital for infectious and tropical diseases, Belgrade, Serbia

2014 ◽  
Vol 71 (2) ◽  
pp. 131-136
Author(s):  
Ivana Milosevic ◽  
Milos Korac ◽  
Goran Stevanovic ◽  
Djordje Jevtovic ◽  
Branko Milosevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Urinary Tract ◽  
Nosocomial Infections ◽  
Statistical Significance ◽  
University Hospital ◽  
Tropical Diseases ◽  
Electronic Data Base ◽  
Tract Infections

Bacground/Aim. Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them. Methods. This prospective cohort study included 52 patients treated in the Intensive Care Unit from January to June 2004. The diagnosis of NI was established according to the Centers for Disease Control and Prevention (CDC) definition, based on clinical presentation, radiological and microbiological findings, etc. Statistical data processing was done by using the electronic data base organized in SPSS for Windows version 10.0. The level of statistical significance was defined as p < 0. 05. Results. NIs were found in 33 (63.4%) of 52 inpatients. Urinary tract infections (UTIs), pneumonia, and soft tissue infections, the most common nosocomial infections in our setting, were recorded in 41.0%, 25.6%, and 23.1%, of patients, respectively. Several factors contributed to a high incidence of these infections: chronic comorbidities (p < 0.01), the presence of indwelling devices such as urinary tract catheters (p < 0.01), endotracheal tubes (p < 0.05) along with mechanical ventilation (p < 0.05). Conclusion. The majority of patients with NIs had chronic underlying comorbidities. All the patients with UTIs had urinary catheters. The most important risk factors for the development of nosocomial pneumonias were endotracheal intubation and mechanical ventilation. The patients with pneumonia had the highest mortality.

Nosocomial infections and risk factors in intensive care unit of a university hospital in Turkey

Open Medicine ◽  
2010 ◽  
Vol 5 (2) ◽  
pp. 203-208 ◽  
Author(s):  
Burcin Ozer ◽  
Muserref Tatman-Otkun ◽  
Dilek Memis ◽  
Metin Otkun
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Urinary Tract ◽  
Respiratory Tract ◽  
Nosocomial Infections ◽  
Lower Respiratory Tract ◽  
Prolonged Mechanical Ventilation ◽  
University Hospital ◽  
Tract Infections

AbstractThe aim of this study was to determine the types nosocomial infections (NIs) and the risk factors for NIs in the central intensive care unit (ICU) of Trakya University Hospital. The patients admitted to the ICU were observed prospectively by the unit-directed active surveillance method based on patient and the laboratory over a 9-month-period. The samples of urine, blood, sputum or tracheal aspirate were taken from the patients on the first and the third days of their hospitalization in ICU; the patients were cultured routinely. Other samples were taken and cultured if there was suspicion of an infection. Infections were considered as ICU-associated if they developed after 48 hours of hospitalization in the unit and 5 days after discharge from the unit if the patients had been sent to a different ward in the hospital. The rate of NIs in 135 patients assigned was found to be 68%. The most common infection sites were lower respiratory tract, urinary tract, bloodstream, catheter site and surgical wound. Hospitalization in ICU for more than 6 days and colonization was found to be the main risk factor for NIs. Prolonged mechanical ventilation and tracheostomy, as well as frequently changed nasogastric catheterization, were found to be risk factors for lower respiratory tract infections. For bloodstream infections, both prolonged insertion of and frequent change of arterial catheters, and for urinary tract infections, female gender, period and repeating of urinary catheterization were risk factors. A high prevalence rate of nosocomial infections was found in this study. Invasive device use and duration of use continue to greatly influence the development of nosocomial infection in ICU. Important factors to prevent nosocomial infections are to avoid long hospitalization and unnecessary device application. Control and prevention strategies based on continuing education of healthcare workers will decrease the nosocomial infections in the intensive care unit.

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