Pseudomonas Species Bloodstream Infection in Children: Fifteen-year Review

Background: Pseudomonas bloodstream infections (PBSI) are most commonly acquired in hospital. There are limited data on the incidence and characteristics of PBSI, susceptibility to antibiotics, mortality rates, and predictors of mortality in children.

Objective: to evaluate the clinical features and antibiotic susceptibility of PBSI in children, as well as mortality rates and predictors of 30-day mortality.

Methods: A retrospective cohort of children < 18 years of age admitted to Rambam Health Care Campus with PBSI between 2005 and 2020.

Results: A total of 196 patients with PBSI were identified. The median age was 4.27 (0.68-12.56) years. Underlying disease was documented in 81.1% of patients, of whom 61% had hemato-oncologic disease and 30.1% were admitted to the intensive care unit. Most of the children had a central venous catheter (81.6%). P. aeruginosa was the most common species in 81.1%. The susceptibility of Pseudomonas to common antibiotics was reported as follows: amikacin (95%), PIP /TAZ (89%), ceftazidime (88.7%) and carbapenem (87.4%). The 30-day mortality rate was 13.8%. Mortality was associated with decreased albumin level-for each unit increase in albumin level, 30-day mortality decreased by 36.2% (p 0.003, CI:0.104-0.633)-and carbapenem resistance, which was associated with a 5.2-fold increase in mortality risk (p 0.041, CI:1.067-25), and not with adequacy of antibiotic treatment.

Conclusion: PBSI occurs mostly in hospitalized children with underlying diseases. Decreased albumin levels and carbapenem resistance were associated with 30-day mortality. These factors may reflect protracted illness or unremitting contact with health care system.