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Abstract - Bacteremia due to Carbapenemase-producing Enterobacteriaceae in Pediatric Hematology-Oncology Can Be Reduced by Measures of Hospital Infection Control
Desiree Caselli, Antonella Colombini, Daniele Zama, Elio Castagnola, Paola Muggeo, Milena La Spina, Katia Perruccio, Raffaella De Santis, Francesca Carraro, Federico Mercolini, Maria Grazia Petris, Daniela Onofrillo, Rossella Mura, Simone Cesaro

Frequency of Bacteremia due to Carbapenemase-producing Enterobacteriaceae in Pediatric Hematology-Oncology Can Be Reduced by Measures of Hospital Infection Control


Désirée Caselli1, Antonella Colombini2, Daniele Zama3, Elio Castagnola4, Paola Muggeo5, Milena La Spina6, Katia Perruccio7, Raffaella De Santis8, Francesca Carraro9, Federico Mercolini10, Maria Grazia Petris11, Daniela Onofrillo12, Rossella Mura13, Valentina Barretta14, Simone Cesaro14

1Infectious Diseases, Giovanni XXIII Children Hospital, Azienda Ospedaliero Universitaria Consorziale Policlinico, Bari, Italy

2Pediatric Hemato-Oncology, Fondazione MBBM, Milano Bicocca University, San Gerardo Hospital Monza, Italy

3Department of Pediatrics, Pediatric Oncology and Haematology Unit "Lalla Seràgnoli", Sant'Orsola Malpighi Hospital, University of Bologna, Bologna, Italy

4Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy

5Pediatric Oncology / Hematology, Azienda Ospedaliero-Universitaria consorziale Policlinico di Bari, Italy

6Pediatric Hemato-Oncology Unit, Azienda Policlinico Vittorio Emanuele, Catania, Italy

7Pediatric Oncology Hematology, Santa Maria della Misericordia Hospital, Perugia, Italy.

8Pediatric Hematology Oncology, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy.

9Pediatric Onco-Hematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children’s Hospital, Torino, Italy

10Pediatric Hemato-Oncology Unit, Department of Pediatrics, Regional Hospital of Bolzano, Bolzano, Italy

11Dept. Women's and Children's Health, Clinic of Pediatric Hemato-Oncology, University of Padua, Italy

12     Hematology-Oncology Department, Pediatric Hematology and Oncology Unit, Santo Spirito Hospital, Pescara, Italy

13Pediatric Hematology Oncology, Azienda Ospedaliera Brotzu, Cagliari, Italy

14Pediatric Hematology-Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy



Objectives: The spread of carbapenemase-producing Enterobacteriaceae (CPE) is an emerging problem in children undergoing cancer-directed chemotherapy. A previous Italian survey reported a threefold increase in CPE colonization rate and a fourfold increase of CPE bloodstream infections in a 2 year-observation time interval.

Methods: To assess the efficacy of the measures put in place to control this emergency, a second survey was performed in the years 2016-2017 and the results were compared.

Results: The overall rate of colonization was comparable between the two study periods: 0.50% (2016-2017) vs. 0.48% (2012-2013). MDR/CPE bacteremia was now reported in 13 children from six centers. The rate of MDR/CPE bacteremia was 0.12 for 1,000 days of hospitalization (95% CI, 0.07-0.21) and compared favorably with that observed in the previous survey (0.42 for 1,000 days of hospitalization; 95% CI, 0.31-0.57; p<0.0001). The strains responsible for bacteremia were Klebsiella pneumonia in 9/13 children, Escherichia coli in 2/13, Citrobacter spp. and Stenotrophomonas maltophilia in one case each. The antibiotic susceptibility was available for 10 MDR/CPE strains.

Conclusion: The number of patients colonized by CPE remained stable over the years, while the number of bloodstream infections decreased, as well as the resulting mortality. We conclude that children undergoing chemotherapy are at risk for CPE colonization/infection but the awareness of their colonization status may allow reducing CPE morbidity and mortality. J Microbiol Infect Dis 2021; 11(1):27-31.

Keywords: Carbapenemase-producing Enterobacteriaceae, children, oncology, hematology, infection control

Volume 11, Number 01 (2021)