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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

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Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
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Kinderaerzte KurWerk, 3400 Burgdorf, Switzerland
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Pediatric Oncology Institute, GRAACC/Federal University of Sao Paulo, Sao Paulo 04023-062, Brazil
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Facultad de Medicina, Universidad de Chile, Hospital Dr. Luis Calvo Mackenna, Santiago 7500539, Chile
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Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology and Oncology, University Children’s Hospital Muenster, 48149 Muenster, Germany
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The Paediatric Integrated Cancer Service, Parkville, VIC 3052, Australia
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Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia
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Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany
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Pediatric Oncology and Hematology, Children’s Hospital Medical Center, University Clinics, 6642 Homburg, Germany
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Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy
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Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research & Learning, Toronto, ON M5G 0A4, Canada
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Institute of Medical Microbiology, University Hospital Munster, 48149 Munster, Germany
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Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
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Pediatric Unit, Santa Maria Delle Grazie Hospital, ASL Napoli 2 Nord, Pozzuoli, 80027 Napoli, Italy
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Dmitry Rogachev Federal Scientific-Clinical Center of Children’s Hematology, Oncology and Immunology, 117997 Moscow, Russia
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Paediatric Haematology/Oncology Department, Meyer Children’s University Hospital, 50134 Florence, Italy
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Author to whom correspondence should be addressed.
Academic Editor: Michele Bartoletti
Antibiotics 2021, 10(3), 266; https://doi.org/10.3390/antibiotics10030266
Received: 1 February 2021 / Revised: 21 February 2021 / Accepted: 1 March 2021 / Published: 5 March 2021
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. View Full-Text
Keywords: antibiotic resistance; intensive care admission and mortality; bloodstream infections; pediatric patients; chemotherapy; allogeneic stem cell transplant antibiotic resistance; intensive care admission and mortality; bloodstream infections; pediatric patients; chemotherapy; allogeneic stem cell transplant
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Figure 1

MDPI and ACS Style

Castagnola, E.; Bagnasco, F.; Mesini, A.; Agyeman, P.K.A.; Ammann, R.A.; Carlesse, F.; Santolaya de Pablo, M.E.; Groll, A.H.; Haeusler, G.M.; Lehrnbecher, T.; Simon, A.; D’Amico, M.R.; Duong, A.; Idelevich, E.A.; Luckowitsch, M.; Meli, M.; Menna, G.; Palmert, S.; Russo, G.; Sarno, M.; Solopova, G.; Tondo, A.; Traubici, Y.; Sung, L. 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 2021, 10, 266. https://doi.org/10.3390/antibiotics10030266

AMA Style

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. 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. 2021; 10(3):266. https://doi.org/10.3390/antibiotics10030266

Chicago/Turabian Style

Castagnola, Elio, Francesca Bagnasco, Alessio Mesini, Philipp K. A. Agyeman, Roland A. Ammann, Fabianne Carlesse, Maria Elena Santolaya de Pablo, Andreas H. Groll, Gabrielle M. Haeusler, Thomas Lehrnbecher, 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, and Lillian Sung. 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, no. 3: 266. https://doi.org/10.3390/antibiotics10030266

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