{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T20:41:05Z","timestamp":1788381665958,"version":"build-2803163510"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>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 \u2264 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 &gt;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.<\/jats:p>","DOI":"10.3390\/antibiotics10030266","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T05:03:15Z","timestamp":1614920595000},"page":"266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"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"],"prefix":"10.3390","volume":"10","author":[{"given":"Elio","family":"Castagnola","sequence":"first","affiliation":[{"name":"Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1601-9518","authenticated-orcid":false,"given":"Francesca","family":"Bagnasco","sequence":"additional","affiliation":[{"name":"Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Mesini","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8339-5444","authenticated-orcid":false,"given":"Philipp K. A.","family":"Agyeman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1902-2352","authenticated-orcid":false,"given":"Roland A.","family":"Ammann","sequence":"additional","affiliation":[{"name":"Pediatric Hematology\/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland"},{"name":"Kinderaerzte KurWerk, 3400 Burgdorf, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7037-3425","authenticated-orcid":false,"given":"Fabianne","family":"Carlesse","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Institute, GRAACC\/Federal University of Sao Paulo, Sao Paulo 04023-062, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Elena","family":"Santolaya de Pablo","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad de Chile, Hospital Dr. Luis Calvo Mackenna, Santiago 7500539, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1188-393X","authenticated-orcid":false,"given":"Andreas H.","family":"Groll","sequence":"additional","affiliation":[{"name":"Infectious Disease Research Program, Center for Bone Marrow Transplantation and Department of Paediatric Haematology and Oncology, University Children\u2019s Hospital Muenster, 48149 Muenster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle M.","family":"Haeusler","sequence":"additional","affiliation":[{"name":"The Paediatric Integrated Cancer Service, Parkville, VIC 3052, Australia"},{"name":"Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia"},{"name":"Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC 3010, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Lehrnbecher","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9558-3330","authenticated-orcid":false,"given":"Arne","family":"Simon","sequence":"additional","affiliation":[{"name":"Pediatric Oncology and Hematology, Children\u2019s Hospital Medical Center, University Clinics, 6642 Homburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Duong","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research &amp; Learning, Toronto, ON M5G 0A4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evgeny A.","family":"Idelevich","sequence":"additional","affiliation":[{"name":"Institute of Medical Microbiology, University Hospital Munster, 48149 Munster, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Luckowitsch","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Johann Wolfgang Goethe University, 60323 Frankfurt am Main, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7504-314X","authenticated-orcid":false,"given":"Mariaclaudia","family":"Meli","sequence":"additional","affiliation":[{"name":"Pediatric Hemato-Oncology Unit, Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Menna","sequence":"additional","affiliation":[{"name":"Department Hemato-Oncology, AORN Santobono-Pausilipon, 80129 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Palmert","sequence":"additional","affiliation":[{"name":"Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research &amp; 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