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

Castagnola, E; Bagnasco, F; Mesini, A; Agyeman, PKA; Ammann, RA; Carlesse, F; Santolaya de Pablo, ME; Groll, AH; Haeusler, GM; Lehrnbecher, T; Simon, A; D&#39;Amico, MR; Duong, A; Idelevich, EA; Luckowitsch, M; Meli, M; Menna, G; Palmert, S; Russo, G; Sarno, M; Solopova, G; Tondo, A; Traubici, Y; Sung, L

Author(s): Castagnola, E; Bagnasco, F; Mesini, A; Agyeman, PKA; Ammann, RA; Carlesse, F; Santolaya de Pablo, ME; Groll, AH; Haeusler, GM; Lehrnbecher, T; Simon, A; D'Amico, MR; Duong, A; Idelevich, EA; Luckowitsch, M; Meli, M; Menna, G; Palmert, S; Russo, G; Sarno, M; Solopova, G; Tondo, A; Traubici, Y; Sung, L;
Details: Publication Year 2021-02,Volume 10,Issue #3,Page 266
Journal Title: Antibiotics
Publication Type: Research article
Abstract: 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.
Department(s): Infectious Diseases
PubMed ID: 33807654
Publisher's Version: https://doi.org/10.3390/antibiotics10030266
Open Access at Publisher's Site: https://doi.org/10.3390/antibiotics10030266
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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