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)
Abstract
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…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 33,387 participants or records.
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