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Pseudomonas aeruginosa bloodstream infections in children and adolescents: risk factors associated with carbapenem resistance and mortality.
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.
Afiliación
  • Rodríguez NEG; Centro de Salud Canillejas, Pediatría, Madrid, Spain.
  • Aguilera-Alonso D; 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 Complutens
  • Escosa L; 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.
  • Gómez-Gil MR; Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain.
  • Manzanares Á; Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Ascaso MG; Paediatric Infectious Diseases Unit, Hospital Niño Jesús, Madrid, Spain; Universidad Internacional de La Rioja, Logroño, Spain.
  • Bermejo-Gómez A; Department of Paediatrics, Hospital Universitario de Móstoles, Madrid, Spain.
  • Abad MJG; Department of Microbiology, Hospital Universitario Niño Jesús, Madrid, Spain.
  • Ramos AM; Paediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Núñez AS; Paediatric Infectious Diseases Unit, Hospital Niño Jesús, Madrid, Spain.
  • Orellana MÁ; Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Cercenado E; Department of Microbiology, Hospital Universitario Gregorio Marañón, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III. Fundación IdiPaz, Madrid, Spain.
  • Lozano JS; 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.
  • Calvo C; 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.
  • Baquero-Artigao F; 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.
J Hosp Infect ; 149: 56-64, 2024 Jul.
Article en En | MEDLINE | ID: mdl-38735628
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pseudomonas aeruginosa / Infecciones por Pseudomonas / Carbapenémicos / Bacteriemia Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male País/Región como asunto: Europa Idioma: En Revista: J Hosp Infect Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pseudomonas aeruginosa / Infecciones por Pseudomonas / Carbapenémicos / Bacteriemia Límite: Adolescent / Child / Child, preschool / Female / Humans / Infant / Male País/Región como asunto: Europa Idioma: En Revista: J Hosp Infect Año: 2024 Tipo del documento: Article País de afiliación: España Pais de publicación: Reino Unido