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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
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 o...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000765/ https://www.ncbi.nlm.nih.gov/pubmed/33807654 http://dx.doi.org/10.3390/antibiotics10030266 |
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author | 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 |
author_facet | 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 |
author_sort | Castagnola, Elio |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8000765 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-80007652021-03-28 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 Solopova, Galina Tondo, Annalisa Traubici, Yona Sung, Lillian Antibiotics (Basel) Article 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. MDPI 2021-03-05 /pmc/articles/PMC8000765/ /pubmed/33807654 http://dx.doi.org/10.3390/antibiotics10030266 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ). |
spellingShingle | Article 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 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8000765/ https://www.ncbi.nlm.nih.gov/pubmed/33807654 http://dx.doi.org/10.3390/antibiotics10030266 |
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