Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia
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RESEARCH ARTICLE
Open Access
Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia Huiting Xu1,2, Jie Cheng1,2, Qinghong Yu1,2, Qingyuan Li1,2, Qian Yi1,2, Siying Luo1,2, Yuanyuan Li3, Guangli Zhang3, Xiaoyin Tian3, Dapeng Cheng4 and Zhengxiu Luo3*
Abstract Background: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. Methods: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. Results: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 h. Early TTP (≤18 h) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P = 0.014), higher incidence of septic shock (52.4% vs12.9%, P = 0.06), higher Pitt bacteremia scores [3.00 (1.00–5.00) vs 1.00 (1.00–4.00), P = 0.046] and more intensive care unit admission (61.9% vs 22.6%, P = 0.008) when compared with late TTP (> 18 h) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for inhospital mortality (OR 5.88, 95%CI 1.21–21.96, P = 0.035; OR 4.95, 95%CI 1.26–27.50, P = 0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18 h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18–33.77, P = 0.032; OR 8.15, 95%CI 1.15–42.43, P = 0.014; OR 6.46, 95% CI 1.19–33.19 P = 0.031; respectively). Conclusions: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children. Keywords: Pseudomonas aeruginosa, Time to positivity, Bacteremia, Children, Outcomes
Intrudoction Pseudomonas aeruginosa (P. aeruginosa) is responsible for infections with different starting point sites [1]. Poor outcomes usually occurred in critically ill patients infected with P. aeruginosa [2]. Early assessment of the * Correspondence: [email protected] 3 Department of Respiratory Medicine, Children’s Hospital of Chongqing Medical University, Chongqing 401122, China Full list of author information is available at the end of the article
severity of P. aeruginosa bacteremia patients may contribute to assisting the therapy and monitor, so as to improve the outcomes of these patients [3, 4]. Some studies have investigated tools to identify patients at high risk of mortality, such as APACHE scores and PRIS M scores [5, 6]. However, the process of these prognostic scores is complex, which leading to inconvenient in clinical work. Therefore, simpler and easier measurement
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