Antibiotic resistant bloodstream infections in pediatric patients receiving chemotherapy or hematopoietic stem cell transplant: factors associated with development of resistance, intensive care admission and mortality

  • Bloodstream infections (BSI) are a severe complication of antineoplastic chemotherapy or hematopoietic stem cell transplantation (HSCT), especially in the presence of antibiotic resistance (AR). A multinational, multicenter retrospective study in patients aged ≤ 18 years, treated with chemotherapy or HSCT from 2015 to 2017 was implemented to analyze AR among non-common skin commensals BSI. Risk factors associated with AR, intensive care unit (ICU) admission and mortality were analyzed by multilevel mixed effects or standard logistic regressions. A total of 1291 BSIs with 1379 strains were reported in 1031 patients. Among Gram-negatives more than 20% were resistant to ceftazidime, cefepime, piperacillin-tazobactam and ciprofloxacin while 9% was resistant to meropenem. Methicillin-resistance was observed in 17% of S. aureus and vancomycin resistance in 40% of E. faecium. Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant S. aureus was associated with BSI due to this pathogen. Hematological malignancies, neutropenia and Gram-negatives resistant to >3 antibiotics were significantly associated with higher risk of ICU admission. Underlying disease in relapse/progression, previous exposure to antibiotics, and need of ICU admission were significantly associated with mortality. Center-level variation showed a greater impact on AR, while patient-level variation had more effect on ICU admission and mortality. Previous exposure to antibiotics or colonization by resistant pathogens can be the cause of AR BSI. Resistant Gram-negatives are significantly associated with ICU admission and mortality, with a significant role for the treating center too. The significant evidence of center-level variations on AR, ICU admission and mortality, stress the need for careful local antibiotic stewardship and infection control programs.

Download full text files

Export metadata

Author:Elio Castagnola, Francesca Bagnasco, Alessio Mesini, Philipp K. A. Agyeman, Roland A. Ammann, Fabianne Carlesse, Maria Elena Santolaya de Pablo, Andreas H. GrollORCiD, Gabrielle M. Haeusler, Thomas LehrnbecherORCiDGND, Arne Simon, Maria Rosaria D'Amico, Austin Duong, Evgeny A. Idelevich, Marie Luckowitsch, Mariaclaudia Meli, Giuseppe Menna, Sasha Palmert, Giovanna Russo, Marco Sarno, Galina Solopova, Annalisa Tondo, Yona Traubici, Lillian Sung
Parent Title (English):Antibiotics
Place of publication:Basel
Document Type:Article
Date of Publication (online):2021/03/05
Date of first Publication:2021/03/05
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/10/19
Tag:allogeneic stem cell transplant; antibiotic resistance; bloodstream infections; chemotherapy; intensive care admission and mortality; pediatric patients
Issue:3, art. 266
Page Number:14
First Page:1
Last Page:14
The study was partially supported by grants from IRCCS Istituto Giannina Gaslini, Genoa— Italy, and Ministero della Salute, Ricerca corrente 2011, Ricerca scientifica corrente 2011 MSALRC11 DEL.30/12.
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0