Abstract
Bloodstream infections (BSIs) after chemotherapy or hematopoietic stem cell transplantation (HSCT) are a leading cause of morbidity and mortality. Data on 154 BSIs that occurred in 111 onco-hematological patients (57 hematological malignancies, 28 solid tumors, and 26 non-malignant hematological diseases) were retrospectively collected and analyzed. Monomicrobial Gram-positive (GP), Gram-negative (GN), and fungal BSIs accounted for 50% (77/154), 38.3% (59/144), and 3.2% (5/154) of all episodes. Polymicrobial infections were 7.8% (12/154), while mixed bacterial–fungal infections were 0.6% (1/154). The most frequent GN isolates were Escherichia coli (46.9%), followed by Pseudomonas aeruginosa (21.9%), Klebsiella species (18.8%), and Enterobacter species (6.3%). Overall, 18.8% (12/64) of GN organisms were multidrug-resistant (seven Escherichia coli, three Klebsiella pneumoniae, and two Enterobacter cloacae), whereas GP resistance to glycopeptides was observed in 1% (1/97). Initial empirical antibiotic therapy was deemed inappropriate in 12.3% of BSIs (19/154). The 30-day mortality was 7.1% (11/154), while the bacteremia-attributable mortality was 3.9% (6/154). In multivariate analysis, septic shock was significantly associated with 30-day mortality (p = 0.0001). Attentive analysis of epidemiology and continuous microbiological surveillance are essential for the appropriate treatment of bacterial infections in pediatric onco-hematological patients.
Highlights
During recent decades, the improvement of treatments and supportive care of immunocompromised patients with hematological oncological diseases or undergoing stem cell transplantation determined a decrease in mortality and an increase in survival
The severe impairment of innate and adaptive immunity due to underlying disease and chemotherapy explains the high risk of infectious complications in these patients, Bloodstream infections (BSIs) being a major cause of morbidity and mortality [1,2,3]
Mixed bacterial–fungal infections accounted for 0.6% (1/154)
Summary
The improvement of treatments and supportive care of immunocompromised patients with hematological oncological diseases or undergoing stem cell transplantation determined a decrease in mortality and an increase in survival. In patients with suspected BSIs, the timely initiation of empiric antibiotic therapy (EAT) is mandatory to reduce mortality. In the last few decades, BSI epidemiology in hematological–oncological patients has changed, with a significant decrease in Gram-positive (GP) organisms and an increase in Gram-negative (GN) bacteria; more recently, a progressive rise in multidrug-resistant (MDR) strains has been reported [5,6,7,8]. We retrospectively assessed the clinical and microbiological data of all BSI episodes that occurred in a ten-year period at a nine-bed-equipped tertiary-care pediatric hematology–oncology unit to evaluate the etiology and outcome of BSIs, the incidence of MDR bacteria, and the change in EAT over time
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