Pseudomonas aeruginosa bacteremia in children: analysis of trends in prevalence, antibiotic resistance and prognostic factors

Objective. To determine the factors predisposing to Pseudomonas aeruginosa bacteremia as well as the prevalence, source of infection, outcome and prog nostic factors in pediatric patients. Methods. Retrospective review of pediatric patients with P. aeruginosa bact eremia, at a large tertiary care hospital during a 6.5-year period. Results. Seventy patients with P. aeruginosa bacteremia were identified. Th e annual rate of P. aeruginosa bacteremia remained unchanged during the stu dy period. Antibiotic susceptibility remained unchanged except for two pati ents with extensive burns who developed resistant strains. Underlying disea ses were malignancy (50%), prematurity (6%), burns (7%) and others (37%), T he overall mortality associated with P, aeruginosa bacteremia was 20%, The fatality rate was higher among the young infants (compared with older child ren) and those who received previous antibiotic therapy (P = 0.02). Mortali ty rate was higher in nosocomial than in community-acquired ;infections (25 % compared with 11.5%). The mortality rate of low birth weight and burns pa tients was significantly higher when compared with oncology patients or oth er patients, 75 and 40% compared with 11 and 19%, P = 0.01, Multiple regres sion analysis revealed a correlation only between the underlying disease an d mortality (P = 0.02), In the oncology patients the only significant risk factor for mortality was absolute neutrophil count less than or equal to 0. 1 x 10(9)/l (P = 0.06). Conclusion. P. aeruginosa bacteremia, although apparently not increasing in incidence and antibiotic resistance, is still a common serious complicatio n in immunocompromised children with a high mortality rate. We conclude tha t the underlying disease is the main determinant of the clinical outcome.