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Surveillance

 
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Surveillance

"In the expanding group of patients with haematological, solid tumour malignancies or bone marrow transplant recipients, there is currently no standardised strategy for monitoring of infections, despite the fact that these patients have been identified as a nidus for threats from difficult-to-treat infections."

The objective of this stream is to establish a cancer-related infection surveillance network in Australia to address areas of need regarding linkages and information technology requirements for effectual infection surveillance. 

Robust infection surveillance systems are essential for effective and sustainable prevention programs. Such systems have been established nationally for monitoring Staphylococcus aureus bloodstream infections and hand hygiene compliance resulting in standardised surveillance methods, appropriate data handling, and timely data. Aligned with these activities, healthcare performance benchmarks have been developed and mandated for use in Australian healthcare facilities. e.g. for hand hygiene compliance of healthcare workers to exceed 75%, and rates of S. aureus bloodstream infections to not exceed 2/10,000 patient days (1). Additional state-wide surveillance is performed in Australia for certain high-risk patient groups: ICU, surgery, and haemodialysis patients.

A pilot study in New South Wales, led by us, identified that in the haematology population, the proportion of bacteremias due to Gram negative organisms has increased to almost 60% and that over one quarter of these occur in patients colonised by multi-resistant gram-negatives, indicating a growing reservoir of these organisms in vulnerable patients. The burden of illness associated with all the above infections is substantial due to prolonged hospitalisation, consequent potentially toxic antimicrobial treatment regimens of prolonged duration, enhanced infection prevention activities (isolation, gowning and gloving), delays in delivery of cancer-specific therapies and excess healthcare costs.

The NCIC model will allow knowledge to be translated from key stakeholders in infection prevention, providing a mechanism for benchmarking and prediction.

1.Worth LJ, Thursky KA, Slavin MA., Med J Aust, 2012.

 

Recent publications

Clostridium difficile infection (CDI) is the underlying cause in a significant proportion of healthcare-related diarrhoea. Cancer patients are at particular risk of developing a severe, and potentially fatal, CDI. Despite high mortality rates in cancer patients, current prevention and treatment strategies for CDI are not widely implemented. In a recent case-control study of hospital admissions between 2013 and 2015 we found that severe infections were common and chemotherapy, gastro-intestinal/abdominal surgery and antibiotic exposure all contribute to the risk faced by cancer patients (1). Of these factors, the indiscriminate administration of prolonged courses of broad-spectrum antibiotic therapy represents an important focus for prevention, and we identified surgical populations as a priority for future interventions. In a recent review of C. difficile infections in patients with cancer, our experts stress that greater surveillance and monitoring of infections in the cancer population are urgently required (2).

In another study of high-risk cancer patients receiving azacitidine therapy, we evaluated medical records of 68 patients with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) receiving therapy between 2002 and 2013, for evidence of any kind of infection (bacterial, viral or fungal). Azacitidine is a nuclear analogue with anti-neoplastic activity, but infection risk associated with this agent has not been extensively examined to date. Notably, we found infection-related mortality rates to be in excess of 20%, and the majority of infections occurred during early phases of therapy (first and second cycles). Robust surveillance has therefore enabled this high-risk time period to be identified for enhanced prevention and early treatment interventions.(3)   

1. Risks factors and outcomes of Clostridium difficile infection in patients with cancer: a matched case-control study. Hebbard AI, Slavin MA, Reed C, Trubiano JA, Teh BW, Haeusler GM, Thursky KA, Worth LJ. Support Care Cancer. 2017

2. The epidemiology of Clostridium difficile infection in patients with cancer. Hebbard AI, Slavin MA, Reed C, Teh BW, Thursky KA, Trubiano JA, Worth LJ. Expert Rev Anti Infect Ther. 2016 

3. Incidence, etiology and timing of infections following azacitidine therapy for myelodysplastic syndromes. Trubiano JA, Dickinson M, Thursky KA, Spelman T, Seymour JF, Slavin MA, Worth LJ. Leuk Lymphoma. 2017 

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