Multidrug resistant Pseudomonas aeruginosa infection in children undergoing chemotherapy and hematopoietic stem cell transplantation

Abstract

Pseudomonas aeruginosa is one leading gram-negative organism associated with nosocomial infections. Bacteremia is life-threatening in the immunocompromised host. Increasing frequency of multi-drug-resistant (MDRPA) strains is concerning. We started a retrospective survey in the pediatric hematology oncology Italian network. Between 2000 and 2008, 127 patients with Pseudomonas aeruginosa bacteremia were reported from 12 centers; 31.4% of isolates were MDRPA. Death within 30 days of a positive blood culture occurred in 19.6% (25/127) of total patients; in patients with MDRPA infection it occurred in 35.8% (14/39). In the multivariate analysis, only MDRPA had significant association with infection-related death. This is the largest series of Pseudomonas aeruginosa bacteremia cases from pediatric hematology oncology centers. Monitoring local bacterial isolates epidemiology is mandatory and will allow empiric antibiotic therapy to be tailored to reduce fatalities.

Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group

“…Data on resistance rates in post-HSCT children are scarce [12,16,29]. Surpr resistance rates were mostly similar in children and in adults in our study.…”

“…Several studies reported risk factors for cephalosporin-resistant, ESBL-pro or MDR bacteria in cancer and HSCT patients [10,12,13,16,22,29,32]. Onl handful describe risk factors for carbapenem-resistant infections in popula involving but not limited to transplant patients, mainly for K. pneumoniae.…”

“…The risk of infection is influenced by local factors, amo prevalence of resistance, prophylactic practices, empiric treatment, and antimicrobial stewardship. Only a handful of studies focus on children and autologous HSCT (auto-HSCT) patients [12,15,16]. This study aimed to des resistance rates and risk factors in GNR bacteremia in HSCT patients, based intercontinental data.…”

“…The majority, however, were perfo countries with high resistance rates in both the hospitalized and general populations [12][13][14]. The risk of infection is influenced by local factors, amo prevalence of resistance, prophylactic practices, empiric treatment, and antimicrobial stewardship.…”

“…studies, mainly limited to single centers or countries, describe rates and ris for specific resistant pathogens, such as extended-spectrum β-lactamase (E producing Enterobacteriaceae or multidrug-resistant (MDR) bacteria in pat with cancer and HSCT recipients [10][11][12][13]. The majority, however, were perfo countries with high resistance rates in both the hospitalized and general populations [12][13][14].…”