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

Medientyp: E-Artikel

Titel: 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

Beteiligte: Castagnola, Elio; Bagnasco, Francesca; Mesini, Alessio; Agyeman, Philipp K. A.; Ammann, Roland A.; Carlesse, Fabianne; Santolaya de Pablo, Maria Elena; Groll, Andreas H.; Haeusler, Gabrielle M.; Lehrnbecher, Thomas; Simon, Arne; D’Amico, Maria Rosaria; Duong, Austin; Idelevich, Evgeny A.; Luckowitsch, Marie; Meli, Mariaclaudia; Menna, Giuseppe; Palmert, Sasha; Russo, Giovanna; Sarno, Marco; Solopova, Galina; Tondo, Annalisa; Traubici, Yona; Sung, Lillian

Erschienen: MDPI AG, 2021

Sprache: Englisch

DOI: 10.3390/antibiotics10030266

ISSN: 2079-6382

Schlagwörter: Pharmacology (medical) ; Infectious Diseases ; Microbiology (medical) ; General Pharmacology, Toxicology and Pharmaceutics ; Biochemistry ; Microbiology

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Beschreibung: 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.

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