PATIENTS AND METHODS
This retrospective study was conducted in 14 Pediatric Oncology and Hematology centers belonging to the Italian Association of Pediatric Hematology and Oncology (AIEOP) over 11-year period from 01/01/2009 to 31/12/2019.
Eligibility criteria were a diagnosis of EG in patients affected by hematologic/oncologic malignancies or bone marrow failure syndromes, aged 0-18 years, microbiologically documented by demonstration of the microorganism in positive culture from wound swab or skin biopsy and/or in positive blood culture. The date of diagnosis corresponded to the first microbiological evidence of infection. Disseminated infection was defined when two or more noncontiguous sites were involved; associated bacteremia was defined when blood culture was positive.
The following information were extracted from the clinical records of the patients: demographic characteristics, type of malignancy, adjunctive risk factors occurring until 7 days before the diagnosis of infection (corticosteroid treatment, iatrogenic diabetes) clinical symptoms and signs of infection, radiological findings, site of infection, laboratory findings (e.g. neutrophil count, microbiological isolates), treatments received and duration of treatment, outcome, clinical status at last follow-up. Severe and prolonged neutropenia was defined by an absolute neutrophil count <0.5 x 109/L for >10 days. Prolonged use of corticosteroids was defined by a mean minimum dose of 0.3 mg/kg/day of prednisone equivalent for >3 weeks17.
Multi-drug resistance was defined in the presence of isolates with non-susceptibility to at least 3 different drug classes, in accordance with EUCAST international standards and breakpoints.
A descriptive analysis of the data was performed. Univariate analysis of variables regarding clinical presentation between multi drug resistant (MDR) e non-MDR infections was estimated by Fisher exact test. In all analyses a probability value less than 0.05 was considered statistically significant. Data were analyzed using the “R” language statistical software (version 3.6.2).
Patients or parent informed consent was obtained. Data processing was in accordance with Italian law for patient confidentiality and good clinical practice. The study was conducted according to Italian policy for retrospective studies and in accordance with local Ethical Committee judgment.