1206. Pseudomonas aeurginosa (PSA) Bacteremia in Children in Southern China
Session: Poster Abstract Session: Other Bacterial Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background:  

PSA sepsis occurs most commonly in children with impaired immune defenses.  Many but not all are nosocomially-acquired. Invasive PSA infection is uncommon in previously healthy children. Empiric antibiotics may not include agents effective against PSA and can result in poor outcomes. Clinical clues to serious PSA infection would help optimize initial management. 

Methods:  

A retrospective 5 year study (2006-2010) of PSA bacteremia cases under 14 years of age admitted to Soochow Children’s Hospital. Data collected included demographic information, presence of underlying diseases, clinical and laboratory findings, antibiotic susceptibility of PSA, antibiotic therapy, determination if community- or nosocomially-acquired infection, and clinical outcomes. The study was funded by Soochow University and approved by the research ethics board of the Children’s Hospital.

Results:   

PSA bacteremia was detected in 31 children (aged 1-168mo; 2.6% of all postive blood cultures); 13 episodes were community-acquired and 18 nosocomial. 10/13 community-acquired cases occurred in previously healthy children. Overall, 16 children died (case fatality rate 52%), 6 with no underlying condition. Seizures were common (7/10) in previously healthy infants. Significantly higher rates of leukopenia, elevated AST, bilirubin, LDH, CK, and prealbumin were found in non-fatal cases. The only risk factor for mortality in oncology patients was low ANC (P<0.05). In 13/31 cases (42%) PSA was isolated from non-serum sites including CSF, pleural fluid, and peritoneal fluid.  None of the 31 PSA bacteremia isolates was multiresistant. Significantly more children with non-fatal (12/15) than fatal (6/16) cases had an initial antibiotic regimen that covered for PSA (p<0.05).  No difference in case fatality rate (p>0.05) or antibiotic sensitivity (p>0.05) was found between community-acquired verses nosocomial cases.

Conclusion: 

PSA bacteremia is rare in children but if found should prompt investigations for additional sites of infection. Fatality remains high if initial antibiotics do not cover PSA Factors indicative of PSA bacteremia remain hard to define beyond neutropenia.  Prealbumin testing as a marker for PSA bacteremia requires further investigation.


Subject Category: P. Pediatric and perinatal infections

Qingli Zhang, MD, Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou, China; School of Medicine, Xihua Hospital, Shanghai Jiao Tong University, School of Medicine , Shanghai, China, Noni MacDonald, MD, Department of Pediatrics, Dalhousie University, IWK Health Centre, Halifax, NS, Canada and Jennifer Smith, MD, IWK Health Care Centre, Halifax, NS, Canada; Dalhousie University, Halifax, NS, Canada

Disclosures:

Q. Zhang, None

N. MacDonald, None

J. Smith, None

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