A five-year review of Pseudomonas aeruginosa bacteremia in children hospitalized at a single center in southern China.

Background: Pediatric Pseudomonas aeruginosa bacteremia is uncommon. It is mostly seen with impaired immune defenses and is most often nosocomially acquired, but it does occasionally occur in the previously healthy. Empiric antibiotics not effective against P. aeruginosa can result in poor outcomes. To determine the risk factors for P. aeruginosa bacteremia, all pediatric cases of P. aeruginosa bacteremia hospitalized at a single center over a 5-year period were reviewed.

Methods: A retrospective cohort study (2006-2010) of P. aeruginosa bacteremia in children under 14 years of age assessing demographics, the presence of underlying diseases, whether nosocomially acquired, clinical and laboratory findings, P. aeruginosa antibiotic susceptibility, antibiotic therapy, and clinical outcomes was performed.

Results: Thirty-one children, mean age 46 months, had P. aeruginosa bacteremia (2.6% positive blood cultures); 18 cases were nosocomial, none were multi-resistant, and 13 (42%) had P. aeruginosa isolated from a site other than blood. Ten cases occurred in previously healthy children, all of which were community-acquired, and these children were more likely to present with seizures and gastrointestinal findings than those with underlying conditions. The overall case fatality rate was 52% (16/31); 6/16 were previously healthy. Fatal cases had more leukopenia, elevated aspartate aminotransferase, and lower prealbumin A. Fewer fatal cases (6/16 vs. 14/15) had initial antibiotic coverage effective for P. aeruginosa (p=0.002). No difference in case fatality rate (p>0.05) or antibiotic sensitivity (p>0.05) was found between community-acquired and nosocomial cases.

Conclusions: P. aeruginosa bacteremia in children is rare but often fatal if initial antibiotics do not cover P. aeruginosa. Factors indicative of P. aeruginosa bacteremia remain elusive, especially in previously healthy young children. However, P. aeruginosa bacteremia should be considered if children present with a grave illness, seizures, serious gastrointestinal findings, hypotension, and leukopenia.