Abstract
Purpose
Patients with primary immunodeficiency diseases (PID) are perceived to be at high risk for acquiring as well as developing complications from infections. There is little data describing the infection type and frequency these patients may acquire in the community or during hospital admissions. Data is critically needed in order to inform best practices on how to protect these vulnerable patients.
Methods
This is a retrospective study which included PID patients who were discharged from Children’s National Health System (CNHS) from January 1, 2011, through August 31, 2017, and were assigned a discharge diagnosis code indicating PID. Hospitalizations that occurred in the study period were reviewed to extract information on the type of infections upon admission and during hospitalization. The rate of hospital acquired infections (HAIs) was calculated by the number of HAIs divided by the total number of days between date of admission and date of discharge or receiving the first bone marrow transplant, whichever the one came first. The rates were then compared to the HAI rate among oncology patients receiving treatment at CNHS during the same study period.
Results
During this study period, 33 PID patients were admitted 80 times for a total of 1855 patient days. Of these 80 admissions, 31 were due to an infection. Ten of the 31 admissions with severe combined immunodeficiency disease (SCID) were infection related, 4/4 in ectodermal dysplasia with immunodeficiency due to gain of function mutation (IkappaBalpha) patients, 8/10 in Wiskott-Aldrich patients, 1/2 in STAT3 mutation patients, 1/1 in Hyper IGM patient, 1/5 in severe chronic active EBV (SCAEBV) patients, 1/1 NK defect, 2/21 in primary hemophagocytic lymphohistiocytosis patients, 3/4 chronic granulomatous disease, and 0/1 congenital neutropenia. HAI occurred in 11 out of 80 admissions (13.75%). Patients with SCID had the highest HAI rate of 13.09 per 1000 patient days, followed by SCAEBV (11.10), IkappaBalpha (6.58), and Wiskott-Aldrich (4.91). Comparing to oncology patients in which the HAI rate was 0.92 per 1000 patient days. SCID patients had 11.7 (95% confidence interval 3.7–29; p < 0.001) and T cell defects excluding SCID had 4.8 (95% CI 1.0–14.8; p = 0.03) times greater risk of acquiring an infection during a hospitalization.
Conclusions
Patients with severe T cell defects such as SCID are at greater risk for infections in the community and in hospital settings. Additional infection prevention measures are likely needed when caring for these patients in a clinic or as an inpatient. Further studies are urgently needed to determine the most appropriate measures for these patients.
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References
Heimall J, Logan BR, Cowan MJ, et al. Immune reconstitution and survival of 100 SCID patients post-hematopoietic cell transplant: a PIDTC natural history study. Blood. 2017;130(25):2718–27. Accessed May 8, 2018. https://doi.org/10.1182/blood-2017-05-781849.
Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant. 2009;15(10):1143–238. Accessed May 8, 2018. https://doi.org/10.1016/j.bbmt.2009.06.019.
Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 Suppl 2):65. Accessed May 8, 2018–S164. https://doi.org/10.1016/j.ajic.2007.10.007.
Simon A, Ammann RA, Bode U, et al. Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland. BMC Infect Dis. 2008;8:70. Accessed May 8, 2018. https://doi.org/10.1186/1471-2334-8-70.
Reid B, Courtney S. Isolation protocol for patients with severe combined immune deficiency. LymphoSign Journal. 2015;2:165–70. https://doi.org/10.14785/lpsn-2015-0011.
Lehners N, Tabatabai J, Prifert C, Wedde M, Puthenparambil J, Weissbrich B, et al. Long-term shedding of influenza virus, parainfluenza virus, respiratory syncytial virus and nosocomial epidemiology in patients with hematological disorders. PLoS One. 2016;11(2):e0148258. https://doi.org/10.1371/journal.pone.0148258.
Kline S, Cameron S, Streifel A, et al. An outbreak of bacteremias associated with mycobacterium mucogenicum in a hospital water supply. Infect Control Hosp Epidemiol. 2004;25(12):1042–1049. Accessed May 8, 2018. doi: https://doi.org/10.1086/502341. Brenda Reid, Sarah Courtney LymphoSign Journal, 2015, 2(3): 165–170).
Dixon B. Bottled water and bacteria. Lancet Infect Dis. 2008;8(10):590. https://doi.org/10.1016/S1473-3099(08)70212-3.
Sung AD, Sung JAM, Thomas S, et al. Universal mask usage for reduction of respiratory viral infections after stem cell transplant: a prospective trial. Clin Infect Dis. 2016;63(8):999–1006. Accessed Jun 19, 2018. https://doi.org/10.1093/cid/ciw451.
Dhar S, Marchaim D, Tansek R, Chopra T, Yousuf A, Bhargava A, et al. Contact precautions more is not necessarily better. Infection Control & Hospital Epidemiology. 2014;35(3):213–9. https://doi.org/10.1086/675294.
Abad C, Fearday A, Safdar N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect. 2010;76(2):97–102.
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Hanisch, B.R., Davila Saldana, B.J., Keller, M.D. et al. High Rates of Community and Hospital Acquired Infections in Patients with Cellular Immunodeficiencies. J Clin Immunol 38, 804–809 (2018). https://doi.org/10.1007/s10875-018-0552-5
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DOI: https://doi.org/10.1007/s10875-018-0552-5