Infections occur frequently in recipients of cellular therapy or transplant. Questions 180-184 are intended to capture detailed information on clinically significant infections diagnosed during the reporting period. A single infection may be found on multiple cultures or at multiple sites. Infections may recur following resolution of symptoms and negative testing. Use the instructions provided in this section to determine when an infection should be considered clinically significant, and therefore reported, as well as when to report new and / or recurrent infections.
Question 180-184: Did the recipient develop a clinically significant infection since the date of the last report?
Indicate whether the recipient developed a clinically significant bacterial, viral, or fungal infection during the reporting period. For the purpose of this manual, the term “clinically significant” refers to any infection requiring treatment. Surveillance cultures in which normal flora is present and the recipient is asymptomatic do not need to be reported. If no clinically significant infections occurred during the reporting period, report “no” for question 180 and skip to question 185.
Do not report the following scenarios:
- Culture-negative neutropenic fever without clear source;
- Suspected (unconfirmed) viral or bacterial infections;
- Upper respiratory infections which are presumed viral, but no virus has been identified;
- Candida detected in oral or stool samples (includes oral thrush);
- Toenail fungus;
- Yeast infection in the groin, vagina, or under the breasts;
- Surveillance cultures in which normal flora is present and the recipient is asymptomatic;
- Infections persisting from a prior reporting period (including infections which have progressed to new sites since the last report); or
- Infections recurring within the time frames specified in the Definitions for Same Infection table below.
If an organism is identified by molecular report, laboratory report, or other physician documentation, the infection should be reported in questions 181-184. If no organism is identified, the center should use the following guidelines to determine whether to report an infection:
- If a fungal infection is suspected (per radiology assessments), but no organism is isolated during the reporting period, report the suspected infection in questions 180-184.
- If a bacterial or viral infection is suspected, but not confirmed, do not report an infection in questions 180-184.
- If no particular organism group is identified or suspected, do not report an infection in questions 180-184.
For each infection, report the organism, site, and date of diagnosis.
Select the identified or suspected organism as reported on the microbiology report, laboratory report, or other physician documentation. If the specific organism is not listed, use the code “777 – Other organism” and report the name of the organism in the space provided. If a fungal infection is suspected, but not identified, report using code “503 – Suspected fungal infection.” As noted above, only report infections which are clinically significant.
Infections can occur virtually anywhere. In order to capture sufficient detail without excess burden, there is a list for the potential sites. An infection may occur in more than one site at the same or at different times.
- If the infection is identified at multiple sites with the same organism and within the recurrence interval to be considered the same infection (Definitions for Same Infection table), please report all sites the organism was identified.
- If the infection is identified at multiple sites with an organism already reported but is outside of the recurrence interval to be considered the same infection, please report as a new infection.
Select the site(s) of the infection from the options provided on the form. Report all sites of infection which were confirmed by microbiology, laboratory report, or other physician documentation during the reporting period. This includes any new sites identified after the date of diagnosis as well as after treatment has been initiated.
For clarification, the following site definitions are provided:
Blood: includes blood or serum obtained from a central IV line, catheter tip, or from a direct needle stick (Peripheral draw). Blood should be the reported site for infections identified in the bone marrow.
Bone: an infection in the bone itself (Osteomyelitis)
CNS: includes CSF (cerebrospinal fluid) specimens as well as abscesses and/or inflammation noted on brain imaging (encephalitis, meningitis)
Eyes: includes infection in any part of the eye (i.e. retinitis)
Genital: includes vagina, penis, perineum, ovaries, scrotum, testes, uterus
GI tract, lower: includes jejunum, ileum, colon, rectum, and stool
GI tract, upper: includes mouth, dentition, esophagus, stomach, and duodenum
Joints: includes fibrous connective tissue and cartilage at any site of bone articulation, typically isolated to a single area (i.e., not a diffuse infection) such as the knee, elbow, or shoulder
Liver/Spleen: includes the gallbladder and biliary tract
Lung: also known as the lower respiratory tract
Skin, cellulitis: a spreading bacterial or viral infection of the skin and tissues beneath the skin
Skin, necrotizing fasciitis: a severe bacterial infection of the fascia, the tissues that line and separate muscles, that causes extensive tissue death including damage to skin and overlying tissues
Sinus and/or upper respiratory tract: all areas from the nose to the throat and sinuses, does not include lungs (report as “Lung”), mouth, or dental infections (report mouth and dental as “GI tract, upper”).
Urinary tract, lower: includes urinary tract infections and cystitis (bladder inflammation)
Urinary tract, upper: includes the kidneys and ureters
Date of Diagnosis:
Report the date of diagnosis of the infection as the collection date for the positive microbiology culture or laboratory report. For suspected fungal infections, enter the date of a radiological test or the date treatment was started as the date of diagnosis. If multiple sites of infection are identified during the reporting period, report the collection date of the first positive microbiology culture or laboratory report.
Copy and complete questions 181-184 to report more than one infection during this reporting period.
For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.
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