Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study

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dc.contributor.authorLópez Cubillos, Juan F
dc.contributor.authorDíaz, Alejandro
dc.contributor.authorCárdenas, Vicky C
dc.contributor.authorCamacho Moreno, German
dc.contributor.authorCantor, Erika
dc.contributor.authorArcila, Eliana M
dc.contributor.authorHurtado, Isabel C
dc.contributor.authorCorrea, Adriana M
dc.contributor.authorTierradentro, Tatiana M
dc.contributor.authorRamirez, Oscar
dc.contributor.authorPortilla, Carlos A
dc.contributor.authorAponte Barrios, Nelson
dc.date.accessioned2025-04-04T15:29:56Z
dc.date.available2025-04-04T15:29:56Z
dc.date.issued2023-10-01
dc.description.abstractBackground: Risk factors for carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-HSCT have not been thoroughly explored. Methods: All children with cancer or post-HSCT who developed Enterobacterales bloodstream infections in two cancer referral centres in major Colombian cities between 2012 and 2021 were retrospectively examined. When the infection episode occurred, carbapenem resistance mechanisms were evaluated according to the available methods. Data were divided in a training set (80%) and a test set (20%). Three internally validated carbapenem-resistant Enterobacterales (CRE) prediction models were created: a multivariate logistic regression model, and two data mining techniques. Model performances were evaluated by calculating the average of the AUC, sensitivity, specificity and predictive values. Results: A total of 285 Enterobacterales bloodstream infection episodes (229 carbapenem susceptible and 56 carbapenem resistant) occurred [median (IQR) age, 9 (3.5-14) years; 57% male]. The risk of CRE was 2.1 times higher when the infection was caused by Klebsiella spp. and 5.8 times higher when a carbapenem had been used for ≥3 days in the previous month. A model including these two predictive variables had a discriminatory performance of 77% in predicting carbapenem resistance. The model had a specificity of 97% and a negative predictive value of 81%, with low sensitivity and positive predictive value. Conclusions: Even in settings with high CRE prevalence, these two variables can help early identification of patients in whom CRE-active agents are unnecessary and highlight the importance of strengthening antibiotic stewardship strategies directed at preventing carbapenem overuse. © 2023 The Author(s). Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
dc.identifier.citationLópez-Cubillos, J. F., Díaz, A., Cárdenas, V. C., Camacho-Moreno, G., Cantor, E., Arcila, E. M., Hurtado, I. C., Correa, A. M., Tierradentro, T. M., Ramirez, O., Dávalos, D. M., & López-Medina, E. (2023). Carbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study. Journal of Antimicrobial Chemotherapy, 78(10), 2462–2470. https://doi.org/10.1093/jac/dkad255
dc.identifier.issn03057453
dc.identifier.urihttps://repositorio.usc.edu.co/handle/20.500.12421/6273
dc.language.isoen
dc.subjectAdolescent
dc.subjectAnti-Bacterial Agents
dc.subjectCarbapenems
dc.subjectChild
dc.subjectFemale
dc.subjectGammaproteobacteria
dc.subjectHematopoietic Stem Cell Transplantation
dc.subjectHumans
dc.subjectMale
dc.subjectNeoplasms
dc.subjectRetrospective Studies
dc.subjectSepsis
dc.subjectcarbapenem
dc.subjectcefepime
dc.subjectcephalosporin derivative
dc.subjectpiperacillin plus tazobactam
dc.subjectquinolone derivative
dc.subjectantiinfective agent
dc.subjectcarbapenem derivative
dc.titleCarbapenem resistance in Enterobacterales bloodstream infections among children with cancer or post-haematopoietic stem cell transplant: a retrospective cohort study
dc.typeArticle

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