The epidemiological landscape of bloodstream infections in children undergoing chemotherapy or haematopoietic cell transplantation: A retrospective study by Infectious Diseases Working Group of Italian Association of Pediatric Hematology and Oncology
Understanding bloodstream infection (BSI) epidemiology is crucial for optimizing antibiotic therapy in paediatric haematology-oncology patients undergoing chemotherapy or haematopoietic cell transplantation (HCT). However, updated paediatric data remain scarce. This multicentre retrospective study analysed BSI epidemiology across 22 Italian centres (2018-2019), assessing pathogens, resistance profiles, empirical antibiotic therapy (EAT) and clinical course with outcomes. Mortality risk factors were evaluated using a Cox regression model. A total of 510 BSI episodes occurred in 396 patients (median age 6.4 years), with an incidence of 2.9 and 5.1 per 1000 inpatient days for chemotherapy and HCT respectively. Multidrug-resistant (MDR), third to fourth generation cephalosporin- and carbapenem-resistant, account for 18.3%, 29.3% and 8.2% of Gram-negative infections respectively. 42.2% of Klebsiella pneumoniae isolates were MDR. Combination EAT was used in 269/510 episodes, with piperacillin-tazobactam+amikacin being most common. Microbiological appropriateness was 82%. Infection-related and 30-day mortality rates were 4.1% and 5.29%, respectively, with appropriate EAT significantly reducing mortality. Our findings highlight the burden of resistant pathogens in paediatric BSIs and emphasize the importance of appropriate EAT in improving outcomes, underscoring the need for treatment strategies tailored to local resistance patterns.
Authors
- Francesco Baccelli (ORCID: https://orcid.org/0000-0001-8313-7288)
- Elio Castagnola (ORCID: https://orcid.org/0000-0002-5336-8429)
- Angelamaria Petrone
- Simone Cesaro (ORCID: https://orcid.org/0000-0002-8698-9547)
- Angelica Barone (ORCID: https://orcid.org/0009-0004-1623-3842)
- Federico Mercolini (ORCID: https://orcid.org/0000-0001-9932-1944)
- S. Conci
- Simona Rinieri
- Cristina Meazza (ORCID: https://orcid.org/0000-0002-1875-9563)
- Daniela Onofrillo
- Antonella Colombini
- Riccardo Masetti (ORCID: https://orcid.org/0000-0002-1264-057X)
- Raffaella De Santis (ORCID: https://orcid.org/0009-0002-8488-1185)
- Maria Vittoria Micheletti
- Gloria Tridello
- Francesca Trevisan
- Nagua Giurici (ORCID: https://orcid.org/0000-0002-0301-4884)
- Paola Muggeo (ORCID: https://orcid.org/0000-0001-8813-3200)
- Manuela Spadea (ORCID: https://orcid.org/0000-0001-7728-904X)
- Grazia Maria Virzì (ORCID: https://orcid.org/0000-0001-7934-9800)
- Lorenzo Chiusaroli (ORCID: https://orcid.org/0009-0001-9633-873X)
- Katia Perruccio (ORCID: https://orcid.org/0000-0003-0431-3197)
- Francesca Compagno (ORCID: https://orcid.org/0000-0002-0208-9534)
- Alessia Pancaldi (ORCID: https://orcid.org/0000-0002-7414-3413)
- Daniele Zama (ORCID: https://orcid.org/0000-0002-9895-5942)
- Rosamaria Mura (ORCID: https://orcid.org/0000-0002-6928-7121)
- Milena La Spina (ORCID: https://orcid.org/0000-0002-0176-7380)
- Francesco Delle Cave (ORCID: https://orcid.org/0000-0002-3535-5333)
Institutions
- University of Modena and Reggio Emilia (IT)
- University of Padua (IT)
- IRCCS Materno Infantile Burlo Garofolo (IT)
- Casa Sollievo della Sofferenza (IT)
- Istituto Giannina Gaslini (IT)
- University of Catania (IT)
- Ospedale Santa Chiara (IT)
- Ospedale di Bolzano (IT)
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari (IT)
- Azienda Ospedaliera San Gerardo (IT)
- Meyer Children's Hospital (IT)
- Ospedale Santa Maria (IT)
- Azienda USL di Bologna (IT)
- Policlinico Universitario di Catania (IT)
- Ospedale di Parma (IT)
- Ospedale Regina Margherita (IT)
- Azienda USL di Pescara (IT)
- Ospedale Sant'Anna (IT)
- Children's Research Hospital (JP)
- Policlinico San Matteo Fondazione (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- St. Anna Hospital (DE)
- Fondazione IRCCS Istituto Nazionale dei Tumori (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- Azienda Ospedaliera G. Brotzu (IT)
- University of Turin (IT)
Publication Details
- Journal
- British Journal of Haematology
- Published
- 2025-09-21
- DOI
- https://doi.org/10.1111/bjh.70036
- Citations
- 2
- Primary Topic
- Neutropenia and Cancer Infections
- Type
- article
- Field-Weighted Citation Impact
- 2.09
Funders
- Ministero della Salute