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, 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; ... (2021). 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. Antibiotics, 10(3) MDPI 10.3390/antibiotics10030266

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine
04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Paediatric Medicine > Paediatric Infectiology

UniBE Contributor:

Agyeman, Philipp Kwame Abayie and Ammann, Roland

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

2079-6382

Publisher:

MDPI

Language:

English

Submitter:

Christoph Aebi

Date Deposited:

11 Aug 2021 16:02

Last Modified:

11 Aug 2021 19:10

Publisher DOI:

10.3390/antibiotics10030266

PubMed ID:

33807654

Uncontrolled Keywords:

allogeneic stem cell transplant antibiotic resistance bloodstream infections chemotherapy intensive care admission and mortality pediatric patients

BORIS DOI:

10.48350/157807

URI:

https://boris.unibe.ch/id/eprint/157807

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