TY  - JOUR
A1  - Castagnola, Elio
A1  - Bagnasco, Francesca
A1  - Mesini, Alessio
A1  - Agyeman, Philipp K. A.
A1  - Ammann, Roland A.
A1  - Carlesse, Fabianne
A1  - Pablo, Maria Elena Santolaya de
A1  - Groll, Andreas H.
A1  - Haeusler, Gabrielle M.
A1  - Lehrnbecher, Thomas
A1  - Simon, Arne
A1  - D'Amico, Maria Rosaria
A1  - Duong, Austin
A1  - Idelevich, Evgeny A.
A1  - Luckowitsch, Marie
A1  - Meli, Mariaclaudia
A1  - Menna, Giuseppe
A1  - Palmert, Sasha
A1  - Russo, Giovanna
A1  - Sarno, Marco
A1  - Solopova, Galina
A1  - Tondo, Annalisa
A1  - Traubici, Yona
A1  - Sung, Lillian
T1  - 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
T2  - Antibiotics
N2  - 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.
KW  - antibiotic resistance
KW  - intensive care admission and mortality
KW  - bloodstream infections
KW  - pediatric patients
KW  - chemotherapy
KW  - allogeneic stem cell transplant
Y1  - 2021
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/62149
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-621496
SN  - 2079-6382
N1  - 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.
VL  - 10
IS  - 3, art. 266
SP  - 1
EP  - 14
PB  - MDPI
CY  - Basel
ER  -