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Published on: February 23, 2014
Pseudomonas Bacteremia in Children: Clinical and Microbiologic Features and Risk Factors of Mortality: A
Rozeen Abu Shqara1, Imad Kassis1,2, Ranaa Damouni Shalabi1,2
1From the Department of Paediatrics.
Insights
Pseudomonas bacteremia in children is often healthcare-associated, with younger age and inappropriate antibiotics increasing mortality risk. Infection control is crucial to prevent severe outcomes from this bacterial infection.
Area of Science:
- Pediatric Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Pseudomonas bacteremia is a significant hospital-acquired infection in children.
- Understanding its clinical features and outcomes is crucial for patient management.
Purpose of the Study:
- To investigate clinical features, antibiotic susceptibility, mortality rates, and risk factors for mortality in pediatric Pseudomonas bacteremia.
Main Methods:
- Retrospective cohort study of children (≤18 years) with Pseudomonas bacteremia from 2005-2020.
- Analysis included clinical data, isolate characteristics, and mortality outcomes.
Main Results:
- 196 pediatric cases identified; 91.8% were healthcare-related.
- Younger age and inappropriate empiric antibiotic treatment were associated with higher mortality.
- Multidrug-resistant (MDR) Pseudomonas isolates also significantly increased mortality risk.
Conclusions:
- Pseudomonas bacteremia in children leads to significant morbidity and mortality, though lower than previously reported.
- Younger age, MDR isolates, and inadequate antibiotic treatment are key mortality predictors.
- Enhanced infection control practices are vital, especially given the vulnerability of hosts in healthcare settings.
Background:
Pseudomonas bacteremia is most commonly acquired in hospital. The aim of this study was to investigate the clinical features and antibiotic susceptibility, mortality rate and risk factors of mortality in children with Pseudomonas bacteremia.
Methods:
A retrospective cohort study that included children 18 years of age or younger admitted to a tertiary hospital with Pseudomonas bacteremia between 2005 and 2020.
Results:
A total of 196 patients with Pseudomonas bacteremia were identified. The proportional rate of Pseudomonas bacteremia was 33.9/100,000 hospital days. Underlying disease was documented in 81.1% of patients, 61% had hemato-oncological disease. Pseudomonas bacteremia was healthcare related in 180 (91.8%) episodes. Multidrug-resistant (MDR) Pseudomonas accounted for 16 (8.2%) and difficult-to-treat organism to 3 (1.5%) of all isolates. Thirty-day mortality was reported in 27 (13.8%) patients, all had Pseudomonas aeruginosa . In multivariate regression analysis, the first model showed that younger age [ P = 0.038, odds ratio (OR) = 1.095, 95% confidence interval (CI): 1.005-1.192] and inappropriate empiric antibiotic treatment ( P = 0.004, OR = 3.584, 95% CI: 1.490-8.621) were significantly associated with higher mortality. The second model also showed higher morality in younger age ( P = 0.021, OR = 1.114, 95% CI: 1.016-1.221) and MDR isolates ( P = 0.001, OR = 9.725, 95% CI: 2.486-38.039).
Conclusions:
Significant morbidity and mortality due to Pseudomonas bacteremia, but relatively lower mortality than previously published. Although young age, MDR isolates and inappropriate antibiotic treatment have been associated with increased mortality, these factors, especially with low prevalence of MDR isolates, may reflect the baseline mortality rate in vulnerable hosts with continuous contact with healthcare facilities facing such severe infection, and more efforts should be made to emphasize infection control practices to prevent such severe infection.
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