Morales-Aguirre JJ, Andrade-Velásquez JK

Language: Spanish
References: 24
Page: 291-300
PDF size: 79.38 Kb.

ABSTRACT

Introduction. Pseudomonas aeruginosa is a common opportunistic pathogen of human and a frequent cause of nosocomial infections, generally with high lethality. Among the principal risk factors for fatal outcome are: severe sepsis, pneumonia and delay in the initiation of effective antimicrobial therapy.
Material and methods. A retrospective case-study at Hospital Infantil de Mexico Federico Gomez including from 1 month to 18 years of age whose diagnosis included bacteremia due to P. aeruginosa between January 2003 and December 2005. The objective of the study was to identify factors associated with mortality and the antimicrobial susceptibility pattern of the P. aeruginosa isolates. The predisposing risk factors included: previous antibiotic therapy, hospitalization in the pediatric intensive care unit (PICU), surgery, mechanical ventilation, immunosuppressive therapy, and intravenous catheter placement within the 30 days prior to developing bacteremia. In oncologic patients, the type and staging of the malignancy and the absolute neutrophil count were additional risk factor.
Results. During the study period, we identified 108 bacteremic events in 103 patients. There were 63 (58%) females, and in 65 (60%) the events were deemed to be nosocomial. The overall mortality was 21/108 (19%), and was higher (21%), in nosocomial events. The mortality in children with ‹200 absolute neutrophil count was 22% (7/31) and 18% in those with ›200 neutrophil (P =0.60). Factors associated with the highest mortality due to P. aeruginosa included septic shock (P ‹0.0001), lactate ›1.5 and 2 (P =0.0007 vs P =0.0001, respectively), as well as inappropriate antibiotic therapy at the time bacteremia was diagnosed (P =0.03). Antibiotic resistance to carbapenems was documented in 35-40% of the P. aeruginosa nosocomial and community isolates, respectively. There was a 90-100% susceptibility to third and fourth generation antipseudomonal cephalosporins.
Conclusions. Bacteremias due to P. aeruginosa were associated with a high mortality rate and were principally found in immunocompromised patients. Among the main predisposing factors associated with mortality were: neutropenia with an absolute neutrophil count ‹200 cells/mL, the presence of septic shock, serum lactate ›2 mmol/L and having received previous antibiotic therapy.

REFERENCES

1. Aliaga L, Mediavilla D, Cobo F. A clinical index predicting mortality with P. aeruginosa bacteriemia. Clin Med Microbiol. 2002; 51: 615-9.

2. Fergie JE, Shema SJ, Lott L, Crawfold R, Patrick CC. P. aeruginosa bacteriemia in immunocompromised children: analysis of factors associated with poor outcome. Clin Infect Dis. 1994; 18: 390-4.

3. Infecciones nosocomiales, Dirección General de Salud Pública de México; 2004. Vol. 41.

4. Jones R, Kirby J, Beach M. Geographic variations in activity of broad-spectrum b lactams against P. aeruginosa: summary of the worldwide SENTRY antimicrobial surveillance program (1997-2000). Diagn Microbiol Infect Dis. 2002; 43: 239-43.

5. Gibb AP, Tribuddharat C, Moore RC. Nosocomial outbrakes of carbapenem-resistant P. aeruginosa with a new bla-IMP allele, blaIMP-7. Antimicrob Agents Chemother. 2002; 46: 255-8.

6. Livermore D. Multiple mechanisms of antimicrobial resistance in P. aeruginosa: our worst nightmare? Clin Infect Dis. 2002; 32: 634-40.

7. Cheol-In K, Sung-Han K, Hong-Bin K. Pseudomonas aeruginosa bacteriemia: risk factors for mortality and influence of delayed receipt of effective antimicrobial therapy on clinical outcome. Clin Infect Dis. 2003; 37: 745-51.

8. Grisaru-Soen G, Lerner-Geva L, Keller N. Pseudomonas aeruginosa bacteriemia in children: analysis of trends in prevalence, antibiotic resistance and prognostic factors. Pediatr Infect Dis J. 2000; 19: 959-63.

9. Scott T, Ann E, Ritchie D. Pseudomonas aeruginosa bloodstream infection: Importance of appropriate initial antimicrobial treatment. Antimicrob Agents Chemother. 2005; 49: 1306-11.

10. Pollack M. Pseudomonas aeruginosa. En: Mandell G, Benett J, Dolin R, editores. Principles and practice of infectious diseases. 6th ed. Philadelphia: Elsevier; 2005. p. 2587-600.

11. Feigin R, Cherry J, Demmler G, Kaplan S. Textbook of pediatrics infectious diseases. 5th ed. Philadelphia: Saunders; 2004. p. 1557-70.

12. Leigh L, Stoll BJ, Rahman M, McGowan J. Pseudomonas aeruginosa infection in very low birth weight infants: a case control study. Pediatr Infect Dis J. 1995; 14: 367-71.

13. Patrick C. Clinical management of infections in immunocompromised infants and children. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 111-7, 282-301, 353-79.

14. Gallagher PG, Watanakunakorn C. Pseudomonas aeruginosa bacteriemia in a community teaching hospital 1980-1988. Rev Infect Dis. 1989; 11: 846-52.

15. Jackson MA, Wong KY, Lampkin B. Pseudomonas aeruginosa septicemia in childhood cancer patients. Pediatr Infect Dis J. 1992; 1: 239-41.

16. Rivera R, Cárdenas R, Paredes R. Hemato-oncología pediátrica. 2da ed. Mexico: ETM; 2006. p. 215-34.

17. Robison L, Sather H, Coccia P. Assessment of the interrelationship of prognostic factors in childhood acute lymphoblastic leukemia. Am J Pediatr Hematol Oncol. 1980; 2: 3-5.

18. Sala A, Pencharz P, Barr R. Children, cancer and nutrition- a dynamic triangle in review. Cancer. 2003; 100: 677-87.

19. Pittet D, Wenze RP. Nosocomial blood stream infections: secular trends in rates, mortality, and contribution to total hospital death. Arch Intern Med. 1995; 155: 1117-84.

20. Siegman-Igra Y, Ravona R, Primerman H, Giladi M. Pseudomonas aeruginosa bacteriemia: an analysis of 123 episodes with particular emphasis on the effect of antibiotic therapy. Int J Infect Dis. 1998; 2: 211-5.

21. Vidal F, Mensa J, Almela M. Epidemiology and outcome of P. aeruginosa bacteriemia, with especial emphasis on the influence of antibiotic treatment. Analysis of 189 episodes. Arch Intern Med. 1996; 156: 2121-6.

22. Vázquez F, Mendoza MC, Villar MH, Vindel A, Méndez FJ. Characteristics of P. aeruginosa strains causing septicemia in a Spanish hospital 1981-1990. Eur J Clin Microbiol Infect Dis. 1992; 11: 698-703.

23. Ramphal R, Ambrose P. Extended- Spectrum b-lactamases and clinical outcomes: current data. Clin Infect Dis. 2006; 42 Supl 4: S164-S72.

24. Lagatolla C, Tonin E, Monti-Bragadin C, Dolzani L. Endemic carbapenem resistant P. aeruginosa with acquired metallo-b- lactamase determinants in European Hospital. Eur Infect Dis. 2004; 40: 505-7.