Challenges and advances in infection control of hematopoietic stem cell transplant recipients

Hematopoietic Stem Cell Transplantation (HSCT) has revolutionized the outcome of many malignant and non-malignant disorders; however, infection still accounts for a substantial number of deaths after both allogeneic and autologous transplants. Hospital-acquired infections (HAI) such as bloodstream infections, pneumonias, and diarrhea are common in this population and account for significant morbidity and cost of care. Also, there is renewed focus on epidemiologically important organisms as the cause of HAI, most notably methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multi-drug resistant gram-negative bacilli, and Clostridium difficile. We review the infectious risks of HSCT, including those due to HAI as well as measures to decrease these infectious complications. This includes discussion of measures to implement prior to transplant and measures to implement during the pre-engraftment phase, post-engraftment phase, and late phase after transplantation. Additionally, general infection control measures related to healthcare worker behavior as well as environmental control are reviewed. Despite the marked advances in the field of HSCT, challenges remain for clinicians and researchers to conduct properly designed studies to better describe the epidemiology of, risks for, and measures for prevention of transplant related infections.