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
Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.
Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy.
Antibiotics (Basel). 2021 Mar 5;10(3):266. doi: 10.3390/antibiotics10030266.
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 and vancomycin resistance in 40% of . Previous exposure to antibiotics, especially to carbapenems, was significantly associated with resistant Gram-negative BSI while previous colonization with methicillin-resistant 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.
血流感染（BSI）是抗肿瘤化疗或造血干细胞移植（HSCT）的严重并发症，尤其是在存在抗生素耐药性（AR）的情况下。开展了一项针对2015年至2017年接受化疗或HSCT的≤18岁患者的多中心、跨国回顾性研究，以分析非常见皮肤共生菌引起的血流感染中的抗生素耐药情况。通过多水平混合效应或标准逻辑回归分析与抗生素耐药、重症监护病房（ICU）收治及死亡率相关的危险因素。1031例患者共报告了1291例血流感染，分离出1379株菌株。在革兰阴性菌中，超过20%对头孢他啶、头孢吡肟、哌拉西林-他唑巴坦和环丙沙星耐药，而9%对美罗培南耐药。17%的[此处原文缺失具体细菌名称]对甲氧西林耐药，40%的[此处原文缺失具体细菌名称]对万古霉素耐药。既往使用过抗生素，尤其是碳青霉烯类抗生素，与革兰阴性菌血流感染耐药显著相关，而既往定植有耐甲氧西林[此处原文缺失具体细菌名称]与该病原体引起的血流感染相关。血液系统恶性肿瘤、中性粒细胞减少及对>3种抗生素耐药的革兰阴性菌与入住ICU的较高风险显著相关。疾病复发/进展时的基础疾病、既往使用抗生素及入住ICU的需求与死亡率显著相关。中心水平的差异对抗生素耐药的影响更大，而患者水平的差异对入住ICU及死亡率的影响更大。既往使用抗生素或耐药病原体定植可能是抗生素耐药性血流感染的原因。耐药革兰阴性菌与入住ICU及死亡率显著相关，治疗中心也起着重要作用。中心水平在抗生素耐药、入住ICU及死亡率方面差异的显著证据，强调了谨慎实施当地抗生素管理和感染控制计划的必要性。
