Garg Priya, Singh Nikhil, Liu Alice J, Yong Michelle K, Slavin Monica A, Hall Lisa, Worth Leon J
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
BMJ Open. 2025 Aug 1;15(7):e100798. doi: 10.1136/bmjopen-2025-100798.
INTRODUCTION: The immunocompromised host (ICH) is at increased risk for a range of opportunistic and healthcare-associated infections (OI/HAIs). With increased use of novel therapeutics and prolonged survival, the malignancy and transplant population is a particularly vulnerable and expanding subgroup. In the absence of a coordinated Australian infection surveillance programme, estimates of the prevalence of OI/HAIs for the high-risk ICH population are yet to be established. Approaches to infection prevention and control (IPC) are also non-standardised across healthcare facilities (HCFs). This study aims to provide data on key pathogen prevalence and comparative IPC and infection monitoring practice amongst the Australian cancer/transplant population to inform future consensus ICH-specific policy. METHODS AND ANALYSIS: The first multi-site adapted point prevalence survey (PPS) for OI/HAIs in the high-risk ICH population will be conducted across several Australian public HCFs providing inpatient (IP) care for adult transplant (solid organ/haematopoietic stem-cell)±malignancy (haematological/oncological) patients. Surveillance methodology using the European Centre for Disease Prevention and Control (ECDC) PPS protocol modified for the ICH will be applied. ICH-adapted ECDC and Centres for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) surveillance case definitions will be used for key HAIs and diagnostic criteria for select OIs. Potentially eligible cancer and transplant patients will be identified for sampling by active antimicrobial use. Infection data, patient-level risks and correlates for HCF impact will be collected from medical records. To contextualise infectious rates, IPC and surveillance strategy will be explored through qualitative interviews with IPC personnel at each sampling site. The prevalence of infection will be approximated from the proportion with infection in the sample screened, and descriptive data analysis will be used to support the expected outcomes of this study, which includes providing a unique insight into infectious disease trends alongside current IPC and surveillance processes within this highly specialised population. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Peter MacCallum Cancer Centre (PMCC) Human Research Ethics Committee (HREC/112164/PMCC) via the National Mutual Acceptance Scheme. Research findings will be disseminated through peer-review publication and conference presentation and contribute to future work on consensus IPC and surveillance guidelines.
引言:免疫功能低下宿主(ICH)发生一系列机会性感染和医疗保健相关感染(OI/HAIs)的风险增加。随着新型疗法的使用增加和生存期延长,恶性肿瘤和移植人群是一个特别脆弱且不断扩大的亚组。在澳大利亚缺乏协调一致的感染监测计划的情况下,高风险ICH人群中OI/HAIs患病率的估计尚未确定。各医疗机构(HCFs)的感染预防与控制(IPC)方法也未标准化。本研究旨在提供有关澳大利亚癌症/移植人群中主要病原体患病率以及IPC和感染监测实践比较的数据,以为未来针对ICH的共识性政策提供参考。 方法与分析:将在澳大利亚几家为成年移植(实体器官/造血干细胞)±恶性肿瘤(血液学/肿瘤学)患者提供住院(IP)护理的公立HCFs中,开展针对高风险ICH人群的OI/HAIs的首次多中心适应性现患率调查(PPS)。将采用经针对ICH修改的欧洲疾病预防控制中心(ECDC)PPS方案的监测方法。针对主要HAIs,将使用经ICH调整的ECDC以及疾病控制与预防中心(CDC)/国家医疗安全网络(NHSN)监测病例定义和选定OI的诊断标准。将通过主动抗菌药物使用情况来确定潜在符合条件的癌症和移植患者以进行抽样。将从医疗记录中收集感染数据、患者层面的风险以及HCF影响的相关因素。为了解感染率的背景情况,将通过对每个抽样地点的IPC人员进行定性访谈来探索IPC和监测策略。感染患病率将根据筛查样本中的感染比例来估算,描述性数据分析将用于支持本研究的预期结果,包括对这一高度专业化人群中传染病趋势以及当前IPC和监测流程提供独特见解。 伦理与传播:已通过国家相互认可计划获得彼得·麦卡勒姆癌症中心(PMCC)人类研究伦理委员会(HREC/112164/PMCC)的伦理批准。研究结果将通过同行评审发表和会议报告进行传播,并为未来关于IPC和监测指南的共识性工作做出贡献。
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