Pseudomonas aeruginosa bloodstream infections in children and adolescents: risk factors associated with carbapenem resistance and mortality

Pseudomonas aeruginosa bloodstream infections (PA-BSIs) are a serious disease and a therapeutic challenge due to increasing resistance to carbapenems. Our objectives were to describe the prevalence and risk factors associated with carbapenem resistance (CR) and mortality in children with PA-BSI. A r...

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Published in:	The Journal of hospital infection Vol. 149; pp. 56 - 64
Main Authors:	Rodríguez, N.E.G., Aguilera-Alonso, D., Escosa, L., Gómez-Gil, M.R., Manzanares, Á., Ascaso, M.G., Bermejo-Gómez, A., Abad, M.J.G., Ramos, A.M., Núñez, A.S., Orellana, M.Á., Cercenado, E., Lozano, J.S., Calvo, C., Baquero-Artigao, F., Grasa, C., Sánchez Castellano, M., Rodríguez-Molino, P., Castro Martínez, M., de Llano, B.B.Q., San Juan, I.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-07-2024
Subjects:	Adolescent Anti-Bacterial Agents - pharmacology Anti-Bacterial Agents - therapeutic use Antibacterial agents Antimicrobial resistance Bacteremia - drug therapy Bacteremia - epidemiology Bacteremia - microbiology Bacteremia - mortality beta-Lactam Resistance Bloodstream infections Carbapenems - pharmacology Carbapenems - therapeutic use Child Child, Preschool Children Epidemiology Female Humans Infant Male Prevalence Pseudomonas aeruginosa Pseudomonas aeruginosa - drug effects Pseudomonas Infections - drug therapy Pseudomonas Infections - epidemiology Pseudomonas Infections - microbiology Pseudomonas Infections - mortality Retrospective Studies Risk Factors Spain - epidemiology Survival Analysis Tertiary Care Centers - statistics & numerical data Spain Bloodstream infections Pseudomonas aeruginosa Antimicrobial resistance Children Antibacterial agents Epidemiology
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Summary:	Pseudomonas aeruginosa bloodstream infections (PA-BSIs) are a serious disease and a therapeutic challenge due to increasing resistance to carbapenems. Our objectives were to describe the prevalence and risk factors associated with carbapenem resistance (CR) and mortality in children with PA-BSI. A retrospective, multi-centre study was carried out, including patients aged <20 years with PA-BSI in four tertiary hospitals in Madrid (Spain) during 2010–2020. Risk factors for CR PA-BSIs and 30-day mortality were evaluated in a multi-variable logistic regression model. In total, 151 patients with PA-BSI were included, with a median age of 29 months (interquartile range: 3.5–87.1). Forty-five (29.8%) cases were CR, 9.9% multi-drug resistant and 6.6% extensively drug resistant. The prevalence of CR remained stable throughout the study period, with 26.7% (12/45) of CR mediated by VIM-type carbapenemase. Patients with BSIs produced by CR-PA were more likely to receive inappropriate empiric treatment (53.3% vs 5.7%, P<0.001) and to have been previously colonized by CR-PA (8.9% vs 0%, P=0.002) than BSIs caused by carbapenem-susceptible P. aeruginosa. CR was associated with carbapenem treatment in the previous month (adjusted odds ratio (aOR) 11.15) and solid organ transplantation (aOR 7.64). The 30-day mortality was 23.2%, which was associated with mechanical ventilation (aOR 4.24), sepsis (aOR 5.72), inappropriate empiric antibiotic therapy (aOR 5.86), and source control as a protective factor (aOR 0.16). This study shows a concerning prevalence of CR in children with PA-BSIs, leading to high mortality. Inappropriate empiric treatment and sepsis were associated with mortality. The high prevalence of CR with an increased risk of inappropriate empiric treatment should be closely monitored.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0195-6701 1532-2939 1532-2939
DOI:	10.1016/j.jhin.2024.03.022