{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T19:45:46Z","timestamp":1788378346367,"version":"build-2803163510"},"reference-count":64,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X25000662_as1\"><jats:title>Objective:<\/jats:title><jats:p>To identify and present the pathogens and sources of contamination linked to outbreaks within hematopoietic stem cell transplant (HSCT) units.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000662_as2\"><jats:title>Design:<\/jats:title><jats:p>Systematic review.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000662_as3\"><jats:title>Setting:<\/jats:title><jats:p>Inpatient HSCT units.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000662_as4\"><jats:title>Methods:<\/jats:title><jats:p>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 \u201cstem cell\u201d, \u201cbone marrow\u201d, \u201ctransplant\u201d, \u201ctransplantation\u201d, \u201coutbreak\u201d and \u201cpseudo-outbreak\u201d from inception until July 31, 2024. Data on the type of event, pathogen involved, and source of contamination were extracted from eligible publications.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000662_as5\"><jats:title>Results:<\/jats:title><jats:p>In total, 39 studies including 387 patients were included in this review. The overall mortality rate was 23%. Pathogens identified included adenovirus, RSV, <jats:italic>Pseudomonas aeruginosa<\/jats:italic>, <jats:italic>Aspergillus<\/jats:italic> spp., and non-tuberculous mycobacteria (NTM). <jats:italic>P. aeruginosa<\/jats:italic> outbreaks were associated with contaminated sanitary fixtures (<jats:italic>P<\/jats:italic> = .007) and water (<jats:italic>P<\/jats:italic> = .039), outbreaks caused by NTM were associated with water (<jats:italic>P<\/jats:italic> = .009), while <jats:italic>Aspergillus<\/jats:italic> spp. outbreaks were associated with construction (<jats:italic>P<\/jats:italic> &lt; .001). An index case was identified in 36.8% of viral outbreaks (<jats:italic>P<\/jats:italic> = .016). Other sources included inadequate disinfection and transmission from visitors.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X25000662_as6\"><jats:title>Conclusions:<\/jats:title><jats:p>Our study highlights several associations between pathogens involved in HSCT unit outbreaks and their respective sources. Establishing standardized guidelines for unit construction \u2013 particularly for ventilation and water safety \u2013 could further reduce the risk of pathogen transmission and enhance infection prevention in these high-risk settings.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2025.66","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T05:23:46Z","timestamp":1745213026000},"page":"759-769","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":5,"title":["Outbreaks in hematopoietic stem cell transplant units: a systematic 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