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Multicenter Study
. 2025 Nov;207(5):1982-1993.
doi: 10.1111/bjh.70036. Epub 2025 Sep 21.

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 (AIEOP)

Francesco Baccelli  1 , Francesca Compagno  2 , Gloria Tridello  3 , Francesco Delle Cave  2 , Daniele Zama  4 , Riccardo Masetti  1 , Maria Grazia Petris  5 , Lorenzo Chiusaroli  6 , Manuela Spadea  7   8 , Francesca Trevisan  9 , Antonella Colombini  10 , Samantha Conci  3 , Cristina Meazza  11 , Paola Muggeo  12 , Maria Vittoria Micheletti  13 , Alessia Pancaldi  14 , Rosamaria Mura  15 , Daniela Onofrillo  16 , Raffaella De Santis  17 , Milena La Spina  18 , Elio Castagnola  19 , Katia Perruccio  20 , Angelica Barone  21 , Nagua Giurici  22 , Angelamaria Petrone  23 , Federico Mercolini  24 , Simona Rinieri  25 , Simone Cesaro  3
Affiliations
Multicenter Study

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 (AIEOP)

Francesco Baccelli et al. Br J Haematol. 2025 Nov.

Abstract

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.

Keywords: antimicrobial resistance; bloodstream infections; empirical antibiotic therapy; febrile neutropenia; haematopoietic cell transplantation; paediatric haematology; paediatric oncology.

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Conflict of interest statement

The authors declare no conflicts of interest related to this work.

Figures

FIGURE 1
FIGURE 1
Overall mortality in (A) whole cohort and (B) according to treatment phase. T1, 30 days; T2, 90 days. allo, allogenic; auto, autologous; HCT, haematopoietic cell transplantation
See this image and copyright information in PMC

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