Pseudomonas aeruginosa bloodstream infection at a tertiary referral hospital for children
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RESEARCH ARTICLE
Open Access
Pseudomonas aeruginosa bloodstream infection at a tertiary referral hospital for children Joycelyn Assimeng Dame1* , Natalie Beylis2, James Nuttall1 and Brian Eley1
Abstract Background: This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. Methods: A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. Results: The incidence risk of PABSI was 5.4 (95% CI: 4.34–6.54) PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37.4%). Overall, 69/91 (75.8%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (54.9%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24.2% and in multivariable analysis, empiric antibiotic therapy to which PA isolates were not susceptible, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. Conclusions: PABSI caused appreciable mortality, however, appropriate empiric antibiotic therapy was associated with reduced 14-day mortality. Keywords: Pseudomonas aeruginosa bloodstream infection, Children, Sub-Saharan Africa
Background Pseudomonas aeruginosa (PA) is a ubiquitous Gramnegative bacterium usually found in water, soil and plants. Studies from South Africa and Ghana have shown that it causes between 4 and 6.5% of Gramnegative BSI [1–3]. PA typically causes healthcareassociated BSI among children with chronic or malignant diseases that are associated with impaired defence * Correspondence: [email protected]; [email protected] 1 Paediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital and the Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa Full list of author information is available at the end of the article
mechanisms [4, 5]. Community-acquired PA bloodstream infection (PABSI) may manifest in children with other immunodeficiency states including hypogammaglobulinaemia and neutropaenia [6–8]. Communityacquired PABSI has also been reported among previously healthy, young children without underlying medical conditions [9, 10]. The mortality of PABSI is high. In retrospective studies from Argentina and Taiwan, case-fatality rates of 30 and 35% respectively were documented [9, 11]. Risk factors for mortality in children with PABSI include septic shock, multidrug-resistant (MDR) PA
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