{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:59:10Z","timestamp":1784919550268,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T00:00:00Z","timestamp":1702425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC)","award":["CB21\/13\/00009"],"award-info":[{"award-number":["CB21\/13\/00009"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antibiotics"],"abstract":"<jats:p>Objectives: to assess the current epidemiology, antibiotic therapy and outcomes of onco- hematological patients with bacteremic skin and soft-tissue infections (SSTIs), and to identify the risk factors for Gram-negative bacilli (GNB) infection and for early and overall mortality. Methods: episodes of bacteremic SSTIs occurring in cancer patients at two hospitals were prospectively recorded and retrospectively analyzed. Results: Of 164 episodes of bacteremic SSTIs, 53% occurred in patients with solid tumors and 47% with hematological malignancies. GNB represented 45.5% of all episodes, led by Pseudomonas aeruginosa (37.8%). Multidrug resistance rate was 16%. Inadequate empirical antibiotic therapy (IEAT) occurred in 17.7% of episodes, rising to 34.6% in those due to resistant bacteria. Independent risk factors for GNB infection were corticosteroid therapy and skin necrosis. Early and overall case-fatality rates were 12% and 21%, respectively. Risk factors for early mortality were older age, septic shock, and IEAT, and for overall mortality were older age, septic shock and resistant bacteria. Conclusions: GNB bacteremic SSTI was common, particularly if corticosteroid therapy or skin necrosis. IEAT was frequent in resistant bacteria infections. Mortality occurred mainly in older patients with septic shock, resistant bacteria and IEAT. These results might guide empirical antibiotic therapy in this high-risk population.<\/jats:p>","DOI":"10.3390\/antibiotics12121722","type":"journal-article","created":{"date-parts":[[2023,12,13]],"date-time":"2023-12-13T04:14:42Z","timestamp":1702440882000},"page":"1722","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Etiology, Antibiotic Therapy and Outcomes of Bacteremic Skin and Soft-Tissue Infections in Onco-Hematological Patients"],"prefix":"10.3390","volume":"12","author":[{"given":"Valeria","family":"Castelli","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza, 35, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6217-6501","authenticated-orcid":false,"given":"Enric","family":"Sastre-Escol\u00e0","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Puerta-Alcalde","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Clinic of Barcelona\u2014IDIBAPS, 08036 Barcelona, Spain"},{"name":"Departament de Medicina, Facultat de Medicina i Ci\u00e8ncies de la Salut, Campus Cl\u00ednic, Universitat de Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leyre","family":"Huete-\u00c1lava","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Hospital Reina Sof\u00eda de Tudela, 31500 Tudela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6114-7231","authenticated-orcid":false,"given":"J\u00falia","family":"Laporte-Amarg\u00f3s","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Bergas","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Chumbita","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Clinic of Barcelona\u2014IDIBAPS, 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"Mar\u00edn","sequence":"additional","affiliation":[{"name":"Oncology Department, Institut Catal\u00e0 d\u2019Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8907-090X","authenticated-orcid":false,"given":"Eva","family":"Domingo-Domenech","sequence":"additional","affiliation":[{"name":"Hematology Department, Institut Catal\u00e0 d\u2019Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Mar\u00eda","family":"Badia-Tejero","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Pons-Oltra","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Garc\u00eda-Vidal","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Infectious Diseases Department, Hospital Clinic of Barcelona\u2014IDIBAPS, 08036 Barcelona, Spain"},{"name":"Departament de Medicina, Facultat de Medicina i Ci\u00e8ncies de la Salut, Campus Cl\u00ednic, Universitat de Barcelona (UB), 08036 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3209-2563","authenticated-orcid":false,"given":"Jordi","family":"Carratal\u00e0","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3095-4422","authenticated-orcid":false,"given":"Carlota","family":"Gudiol","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain"},{"name":"Institut Catal\u00e0 d\u2019Oncologia (ICO), Hospital Duran i Reynals, IDIBELL, L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/QCO.0000000000000240","article-title":"The importance of source control in the management of severe skin and soft tissue infections","volume":"29","author":"Eckmann","year":"2016","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"iii35","DOI":"10.1093\/jac\/dkq302","article-title":"Complicated skin and soft tissue infection","volume":"65","author":"Dryden","year":"2010","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1155\/2008\/846453","article-title":"Bacterial skin and soft tissue infections in adults: A review of their epidemiology, pathogenesis, diagnosis, treatment and site of care","volume":"19","author":"Ki","year":"2008","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/QCO.0000000000000632","article-title":"The skin and soft tissue infections in hematological patients","volume":"33","author":"Ungaro","year":"2020","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"804518","DOI":"10.1100\/2012\/804518","article-title":"Skin and soft tissue infections in patients with solid tumours","volume":"2012","author":"Kofteridis","year":"2012","journal-title":"Sci. World J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1080\/07853890.2022.2152484","article-title":"Treatment and diagnosis of severe KPC-producing Klebsiella pneumoniae infections: A perspective on what has changed over last decades","volume":"55","author":"Giacobbe","year":"2023","journal-title":"Ann. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"106806","DOI":"10.1016\/j.ijantimicag.2023.106806","article-title":"Bloodstream infections due to Gram-negative bacteria in patients with hematologic malignancies: Updated epidemiology and risk factors for multidrug-resistant strains in an Italian perspective survey","volume":"61","author":"Trecarichi","year":"2023","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_9","first-page":"1068","article-title":"Inappropriate Empirical Antibiotic Treatment in High-risk Neutropenic Patients with Bacteremia in the Era of Multidrug Resistance","volume":"70","author":"Gudiol","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e02494-19","DOI":"10.1128\/AAC.02494-19","article-title":"Clinical Predictive Model of Multidrug Resistance in Neutropenic Cancer Patients with Bloodstream Infection Due to Pseudomonas aeruginosa","volume":"64","author":"Gudiol","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.1093\/cid\/cir073","article-title":"Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america","volume":"52","author":"Freifeld","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1007\/s00277-020-04061-y","article-title":"Necrotizing fasciitis in haematological patients: A different scenario","volume":"99","author":"Pigrau","year":"2020","journal-title":"Ann. Hematol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.15537\/smj.2021.42.12.20210624","article-title":"Skin and soft tissue infections in hospitalized cancer patients: A retrospective study","volume":"42","author":"Egunsola","year":"2021","journal-title":"Saudi Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"E377","DOI":"10.1111\/1469-0691.12235","article-title":"Current management of patients hospitalized with complicated skin and soft tissue infections across Europe (2010\u20132011): Assessment of clinical practice patterns and real-life effectiveness of antibiotics from the REACH study","volume":"19","author":"Garau","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"791","DOI":"10.7326\/0003-4819-137-10-200211190-00007","article-title":"Health care\u2013associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections","volume":"137","author":"Friedman","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_17","unstructured":"The European Committee on Antimicrobial Susceptibility Testing (2023, June 06). Breakpoint Tables for Interpretation of MICs and Zone Diameters. Version 12.0. Available online: http:\/\/www.eucast.org."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., and Lemeshow, S.S.R. (2013). Applied Logistic Regression, Wiley. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S193","DOI":"10.1093\/cid\/ciz002","article-title":"Current Epidemiology, Etiology, and Burden of Acute Skin Infections in the United States","volume":"68","author":"Kaye","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/j.diagmicrobio.2014.02.011","article-title":"Inappropriate initial antibiotic treatment for complicated skin and soft tissue infections in hospitalized patients: Incidence and associated factors","volume":"79","author":"Lipsky","year":"2014","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1080\/21505594.2016.1141161","article-title":"Bloodstream infections in patients with solid tumors","volume":"7","author":"Gudiol","year":"2016","journal-title":"Virulence"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1093\/cid\/cix646","article-title":"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","volume":"65","author":"Averbuch","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4103\/0974-2700.173868","article-title":"Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience","volume":"9","author":"Hadeed","year":"2016","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00068-018-0958-z","article-title":"The roles of early surgery and comorbid conditions on outcomes of severe necrotizing soft-tissue infections","volume":"45","author":"Latifi","year":"2018","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1001\/jamasurg.2013.173","article-title":"Immunocompromised status in patients with necrotizing soft-tissue infection","volume":"148","author":"Keung","year":"2013","journal-title":"JAMA Surg."}],"container-title":["Antibiotics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/12\/1722\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:37:43Z","timestamp":1760132263000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-6382\/12\/12\/1722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,13]]},"references-count":25,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["antibiotics12121722"],"URL":"https:\/\/doi.org\/10.3390\/antibiotics12121722","relation":{},"ISSN":["2079-6382"],"issn-type":[{"value":"2079-6382","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,13]]}}}