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Title

Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality

Authors
Cantoni, Nathan
Weisser, Maja
Buser, Andreas
Arber, Caroline
Stern, Martin
Heim, Dominik
Halter, Jorg
Christen, Susanne
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Published in European Journal of Haematology. 2009, vol. 83, no. 2, p. 130-138
Abstract OBJECTIVE: Nursing in 'live islands' and routine high dose intravenous immunoglobulins after allogeneic hematopoietic stem cell transplantation were abandoned by many teams in view of limited evidence and high costs. METHODS: This retrospective single-center study examines the impact of change from nursing in 'live islands' to care in single rooms (SR) and from high dose to targeted intravenous immunoglobulins (IVIG) on mortality and infection rate of adult patients receiving an allogeneic stem cell or bone marrow transplantation in two steps and three time cohorts (1993-1997, 1997-2000, 2000-2003). RESULTS: Two hundred forty-eight allogeneic hematopoetic stem cell transplantations were performed in 227 patients. Patient characteristics were comparable in the three cohorts for gender, median age, underlying disease, and disease stage, prophylaxis for graft versus host disease (GvHD) and cytomegalovirus constellation. The incidence of infections (78.4%) and infection rates remained stable (rates/1000 days of neutropenia for sepsis 17.61, for pneumonia 6.76). Cumulative incidence of GvHD and transplant-related mortality did not change over time. CONCLUSIONS: Change from nursing in 'live islands' to SR and reduction of high dose to targeted IVIG did not result in increased infection rates or mortality despite an increase in patient age. These results support the current practice.
Keywords AdolescentAdultCohort StudiesDatabases, FactualDose-Response Relationship, DrugFemaleFollow-Up StudiesGraft vs Host Disease/complications/mortality/*prevention & controlHumansImmunoglobulins, Intravenous/*administration & dosage/*therapeutic useInfection/complications/microbiology/therapy/virologyInfection Control/*methodsLength of StayMaleMiddle AgedRetrospective StudiesStem Cell Transplantation/*adverse effects/mortality/*nursingSurvival RateTransplantation, Homologous/adverse effects/mortality/nursingYoung Adult
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PMID: 19284419
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CANTONI, Nathan et al. Infection prevention strategies in a stem cell transplant unit: impact of change of care in isolation practice and routine use of high dose intravenous immunoglobulins on infectious complications and transplant related mortality. In: European Journal of Haematology, 2009, vol. 83, n° 2, p. 130-138. https://archive-ouverte.unige.ch/unige:19725

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Deposited on : 2012-04-23

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