Epidemiology of resistant bacterial infections in patients with hematological malignancies or undergoing hematopoietic cell transplantation in Europe: A systematic review by the European Conference on Infections in Leukemia (ECIL)
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Le résumé fourni par la source
BACKGROUND: Patients with hematological malignancies (HM) or undergoing hematopoietic cell transplantation (HCT) face high risk of bloodstream infections (BSI) during febrile neutropenia. Rising antimicrobial resistance (AMR), especially among Gram-negative (GN) bacteria, challenges effective empirical antibiotic therapy (EAT) selection. This ECIL-10 systematic review updates European resistance epidemiology since the 2011 ECIL-4 guidelines publication to inform clinical recommendations. METHODS: We conducted a systematic review (ID: CRD42025638003) of bacterial epidemiology and resistance in HM/HCT patients across Europe, from June 2011 to September 2024, using PubMed, Embase, and Web of Science according to PRISMA guidelines. We included studies reporting BSI or colonization rates and resistance patterns, including extended-spectrum beta-lactamase-producing/third-generation cephalosporin-resistant (ESBL/3GCR), fluoroquinolone-resistant (FQ-R) carbapenem-resistant (CR), and multidrug-resistant (MDR) for GN bacteria; methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) for Gram-positive (GP) bacteria. Two reviewers independently extracted data with ECDC/EARS-Net surveillance 2011 and 2022 data providing supporting analysis. We examined fluoroquinolone prophylaxis (FQ-P) impact on BSI rate and resistance. RESULTS: Analysis included 40 studies (33,387 patients/febrile episodes from observational studies and 21,402 patients from one meta-analysis) across 12 European countries. BSI prevalence averaged 30% (range, 15-59%), with 42% GN and 51% GP distribution. Median resistance rates among GN BSI were: 55% for FQ-R, 30% for ESBL/3GCR, 13% for both CR and MDR. CR reached 26% in P. aeruginosa (PsA) and 38% in K. pneumoniae (KPn). Among GP BSI resistance was 3% for MRSA and 1% for VRE. Colonization studies demonstrated 20% ESBL/3GCR and 5% CR rates. We identified a southeastern European resistance gradient and significant temporal increase in ESBL/3GCR, CR KPn, and MDR PsA, confirmed in ECDC/EAR-Net analysis. FQ-P reduced overall and GN BSI incidence but increased FQ-R and ESBL/3GCR GN infections in adults. In children, FQ-P reduced BSI in leukemia but not in HCT and data on resistance were inconclusive. ECIL-10 proposed resistance reporting aligned with ESCMID/IDSA guidelines. CONCLUSIONS: AMR presents an escalating challenge in febrile neutropenic HM/HCT patients with geographical variability and increasing resistance trends. These findings strongly support the need for updated guidelines, antimicrobial stewardship programs, rapid diagnostics implementation, and prospective studies to optimize effective empirical therapy strategies.
Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.
Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Epidemiology of resistant bacterial infections in patients with hematological malignancies or undergoing hematopoietic cell transplantation in Europe: A systematic review by the European Conference on Infections in Leukemia (ECIL)
- Date Crossref
- 01/09/2025
- Éditeur
- Elsevier BV
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Azienda USL di Bologna pays non établi dans la noticeÉtablissement de santé
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University of Bologna Department of Medical and Surgical Sciences pays non établi dans la noticeUniversité ou école supérieure
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Instituto de Biomedicina de Sevilla pays non établi dans la noticeStructure de recherche
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Instituto de Salud Carlos III CIBER Enfermedades Infecciosas (CIBERINFEC) pays non établi dans la noticeOrganisme public
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Ospedale Policlinico San Martino pays non établi dans la noticeÉtablissement de santé
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KU Leuven pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Nijmegen pays non établi dans la noticeUniversité ou école supérieure
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Radboud University Medical Center pays non établi dans la noticeOrganisme public
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Hospital General Universitario Gregorio Marañón pays non établi dans la noticeÉtablissement de santé
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University Hospital of Geneva Transplant Infectious Disease Unit pays non établi dans la noticeÉtablissement de santé
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Université Paris-Est Créteil pays non établi dans la noticeUniversité ou école supérieure
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University of Lausanne pays non établi dans la noticeUniversité ou école supérieure
Azienda USL di Bologna, Department of Medical and Surgical Sciences — University of Bologna et Instituto de Biomedicina de Sevilla, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.