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Outbreaks in hematopoietic stem cell transplant units: a systematic review

Published online by Cambridge University Press:  21 April 2025

Loukas Kakoullis Open the ORCID record for Loukas Kakoullis [Opens in a new window] ,
Georges Chedid Open the ORCID record for Georges Chedid [Opens in a new window] ,
Bradley Walker Open the ORCID record for Bradley Walker [Opens in a new window] ,
Vasiliki Xirou Open the ORCID record for Vasiliki Xirou [Opens in a new window] ,
Sufian Abdel Hafez ,
Sokratis N. Zisis ,
Shreya Arora Open the ORCID record for Shreya Arora [Opens in a new window] ,
Costas A. Christophi Open the ORCID record for Costas A. Christophi [Opens in a new window] ,
George Panos  and
Courtney E. Harris Open the ORCID record for Courtney E. Harris [Opens in a new window]
...Show all authors
Loukas Kakoullis*
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Georges Chedid
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Bradley Walker
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Vasiliki Xirou
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Sufian Abdel Hafez
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Sokratis N. Zisis
Affiliation:
Department of Medicine, MetroWest Medical Center, Framingham, MA, USA Tufts University School of Medicine, Boston, MA, USA
Shreya Arora
Affiliation:
Department of Medicine, Mount Auburn Hospital, Cambridge, MA, USA Harvard Medical School, Boston, MA, USA
Costas A. Christophi
Affiliation:
Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol, Cyprus
George Panos
Affiliation:
Department of Internal Medicine, Division of Infectious Diseases, University General Hospital of Patras, Patras, Greece
Courtney E. Harris
Affiliation:
Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA
Robert Colgrove
Affiliation:
Harvard Medical School, Boston, MA, USA Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA, USA
*
Corresponding author: Loukas Kakoullis; Email: [email protected]
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Abstract

Objective:

To identify and present the pathogens and sources of contamination linked to outbreaks within hematopoietic stem cell transplant (HSCT) units.

Design:

Systematic review.

Setting:

Inpatient HSCT units.

Methods:

The PubMed/Medline databases were systematically searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, employing the search terms “stem cell”, “bone marrow”, “transplant”, “transplantation”, “outbreak” and “pseudo-outbreak” from inception until July 31, 2024. Data on the type of event, pathogen involved, and source of contamination were extracted from eligible publications.

Results:

In total, 39 studies including 387 patients were included in this review. The overall mortality rate was 23%. Pathogens identified included adenovirus, RSV, Pseudomonas aeruginosa, Aspergillus spp., and non-tuberculous mycobacteria (NTM). P. aeruginosa outbreaks were associated with contaminated sanitary fixtures (P = .007) and water (P = .039), outbreaks caused by NTM were associated with water (P = .009), while Aspergillus spp. outbreaks were associated with construction (P < .001). An index case was identified in 36.8% of viral outbreaks (P = .016). Other sources included inadequate disinfection and transmission from visitors.

Conclusions:

Our study highlights several associations between pathogens involved in HSCT unit outbreaks and their respective sources. Establishing standardized guidelines for unit construction – particularly for ventilation and water safety – could further reduce the risk of pathogen transmission and enhance infection prevention in these high-risk settings.

Type
Review
Information
Infection Control & Hospital Epidemiology , First View , pp. 1 - 11
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PROSPERO registration number: CRD42024574800.

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