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

N E G Rodríguez; D Aguilera-Alonso; L Escosa; M R Gómez-Gil; Á Manzanares; M G Ascaso; A Bermejo-Gómez; M J G Abad; A M Ramos; A S Núñez; M Á Orellana; E Cercenado; J S Lozano; C Calvo; F Baquero-Artigao; PA-BSI working group

doi:10.1016/j.jhin.2024.03.022

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

J Hosp Infect. 2024 May 10:149:56-64. doi: 10.1016/j.jhin.2024.03.022. Online ahead of print.

Authors

N E G Rodríguez¹, D Aguilera-Alonso², L Escosa³, M R Gómez-Gil⁴, Á Manzanares⁵, M G Ascaso⁶, A Bermejo-Gómez⁷, M J G Abad⁸, A M Ramos⁵, A S Núñez⁹, M Á Orellana¹⁰, E Cercenado¹¹, J S Lozano¹², C Calvo³, F Baquero-Artigao³; PA-BSI working group

Collaborators

PA-BSI working group:
C Grasa, M Sánchez Castellano, P Rodríguez-Molino, M Castro Martínez, B B Q de Llano, I San Juan

Affiliations

¹ Centro de Salud Canillejas, Pediatría, Madrid, Spain.
² Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Universidad Complutense de Madrid, Spain.
³ CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Paediatrics, Infectious, and Tropical Diseases, Hospital La Paz, Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP), Spain.
⁴ Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain.
⁵ Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁶ Paediatric Infectious Diseases Unit, Hospital Niño Jesús, Madrid, Spain; Universidad Internacional de La Rioja, Logroño, Spain.
⁷ Department of Paediatrics, Hospital Universitario de Móstoles, Madrid, Spain.
⁸ Department of Microbiology, Hospital Universitario Niño Jesús, Madrid, Spain.
⁹ Paediatric Infectious Diseases Unit, Hospital Niño Jesús, Madrid, Spain.
¹⁰ Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
¹¹ Department of Microbiology, Hospital Universitario Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III. Fundación IdiPaz, Madrid, Spain.
¹² Paediatric Infectious Diseases Unit, Department of Paediatrics, Hospital Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain; Universidad Complutense de Madrid, Spain.

PMID: 38735628
DOI: 10.1016/j.jhin.2024.03.022

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Antibacterial agents; Antimicrobial resistance; Bloodstream infections; Children; Epidemiology; Pseudomonas aeruginosa.