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.