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Pseudomonas aeruginosa bloodstream infections in children: a 9-year retrospective study

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Abstract

P. aeruginosa bloodstream infection (BSI) is associated with high hospital mortality. Empirical combination therapy is commonly used, but its benefit remains debated. The purpose of this study was to describe in a paediatric population, demographical characteristics and outcome of children treated for P. aeruginosa BSI receiving either a combined or single antibacterial therapy. We performed a retrospective, single-centre, cohort study of hospitalized children with P. aeruginosa BSI from 2007 to 2015. A total of 118 bloodstream infections (BSI) were analysed (102 (86.4%) hospital-acquired, including 52 (44.1%) hospitalized in intensive care unit). In immunocompromised children, 52% of BSI episodes were recorded. Recent medical history revealed that 68% were hospitalized, 31% underwent surgery and 67% had a prior antibiotic therapy within the last 3 months. In-hospital mortality was similar for patients receiving single or combined anti-Pseudomonas therapy (p = 0.78). In multivariate analysis, independent risk factors for in-hospital mortality were neutropenia (OR = 6.23 [1.94–20.01], hospitalization in ICU (OR = 5.24 [2.04–13.49]) and urinary tract infection (OR = 4.40 [1.02–19.25]).

Conclusion: P. aeruginosa BSI mainly occurred in immunocompromised children. Most infections were hospital-acquired and associated with high mortality. Combination therapy did not improve survival.

What is Known:

• P. aeruginosa bloodstream infection (BSI) is associated with high hospital mortality. Empirical combination therapy is commonly used but its benefit remains debated.

What is New:

• This is the largest cohort of Pseudomonas aeruginosa bacteraemia in children ever published. P. aeruginosa Bloodstream mainly occurred in immunocompromised children. Most infections were hospital-acquired and associated with high mortality. Combination therapy did not improve survival.

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Abbreviations

BSI:

Bloodstream infections

CA:

Community-acquired

CBEU:

Cytobacteriological examination of the urine

HA:

Hospital-acquired

ICU:

Intensive care unit

OR:

Odd ratio

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Author information

Authors and Affiliations

  1. Université Paris Descartes, Service de Maladies Infectieuses et Tropicales, Centre d’infectiologie Necker-Pasteur, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Benoît Pilmis, Romain Guery & Olivier Lortholary

  2. Université Paris Descartes, Equipe mobile d’infectiologie, IHU Imagine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Benoît Pilmis, Maria Letizia Fasola, Julie Toubiana, Olivier Lortholary & Jean-Ralph Zahar

  3. Equipe mobile d’infectiologie- Université Paris Descartes, CHU Necker-Enfants malades, 149 rue de Sèvres, 75015 Paris, Paris, France

    Benoît Pilmis

  4. Université Paris Descartes, Service de Pédiatrie Générale et maladies infectieuses Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Fanny Alby-Laurent, Maria Letizia Fasola & Julie Toubiana

  5. SFR du pôle santé : Interactions cellulaires et Applications thérapeutiques, Université d’Angers, DRCI Data management, Angers, France

    Valérie Seegers

  6. Université Paris Descartes, Service de Microbiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France

    Hélène Guet-Revillet & Emmanuelle Bille

  7. Service de Pharmacie, Hôpital Necker Enfants Malades, Paris, France

    Martine Postaire

  8. Université Paris Descartes, Equipe opérationnelle d’hygiène, Hôpital Necker-Enfants Maladies, Assistance Publique-Hôpitaux de Paris, Paris, France

    Jean-Ralph Zahar

Authors
  1. Benoît Pilmis
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  2. Fanny Alby-Laurent
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  9. Emmanuelle Bille
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  11. Jean-Ralph Zahar
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Contributions

BP: collect data, data analysis, writting manuscript. FAL: collect data, review manuscript. MLF: collect data, review manuscript. VS: data analysis, review manuscript. RG: review manuscript. HGR: microbiological analysis, review manuscript. MP: collect data, review manuscript. JT: review manuscript. EB: microbiological analysis, review manuscript. OL: project supervision, review manuscript. JRZ: project supervision, review manuscript.

Corresponding author

Correspondence to Benoît Pilmis.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Communicated by Nicole Ritz

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Cite this article

Pilmis, B., Alby-Laurent, F., Fasola, M.L. et al. Pseudomonas aeruginosa bloodstream infections in children: a 9-year retrospective study. Eur J Pediatr 179, 1247–1254 (2020). https://doi.org/10.1007/s00431-020-03598-4

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  • DOI: https://doi.org/10.1007/s00431-020-03598-4

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