Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.
J Korean Med Sci. 2011 May;26(5):612-8. doi: 10.3346/jkms.2011.26.5.612. Epub 2011 Apr 21.
This study aimed to evaluate the clinical profiles, antibiotic susceptibility, risk factors of multi-drug resistance (MDR) and outcomes of P. aeruginosa bacteremia in children by retrospective methods at a tertiary teaching children's hospital in Seoul, Korea during 2000-2009. A total of 62 episodes were evaluated and 59 patients (95.2%) had underlying diseases. Multivariate analysis demonstrated that an intensive care unit (ICU) stay within the previous one month was the only independent risk factor for MDR P. aeruginosa bacteremia (odds ratio [OR], 6.8; 95% confidence interval [CI], 1.3-35.8, P = 0.023). The overall fatality rate associated with P. aeruginosa bacteremia was 14.5% (9 of 62). The fatality rate in patients with MDR P. aeruginosa was 57.1%, compared with 9.1% in non-MDR patients (OR 13.3; 95% CI 2.3-77.2, P = 0.006). However, the presence of respiratory difficulty was the only independent risk factor for overall fatality associated with P. aeruginosa bacteremia according to multivariate analysis (OR 51.0; 95% CI 7.0-369.0, P < 0.001). A previous ICU stay and presentation with respiratory difficulty were associated with acquisition of MDR P. aeruginosa and a higher fatality rate, respectively. Future efforts should focus on the prevention and treatment of P. aeruginosa bacteremia in high-risk children.
本研究旨在通过回顾性方法评估 2000-2009 年在韩国首尔的一家三级教学儿童医院的儿童铜绿假单胞菌血症的临床特征、抗生素敏感性、多重耐药（MDR）的危险因素和结局。共评估了 62 个病例，59 例（95.2%）患者存在基础疾病。多变量分析表明，在过去一个月内入住重症监护病房（ICU）是 MDR 铜绿假单胞菌血症的唯一独立危险因素（比值比 [OR]，6.8；95%置信区间 [CI]，1.3-35.8，P=0.023）。铜绿假单胞菌血症相关的总死亡率为 14.5%（62 例中的 9 例）。MDR 铜绿假单胞菌血症患者的死亡率为 57.1%，而非 MDR 患者的死亡率为 9.1%（OR 13.3；95%CI 2.3-77.2，P=0.006）。然而，多变量分析显示，存在呼吸窘迫是铜绿假单胞菌血症总死亡率的唯一独立危险因素（OR 51.0；95%CI 7.0-369.0，P<0.001）。先前的 ICU 入住和出现呼吸窘迫分别与获得 MDR 铜绿假单胞菌和更高的死亡率相关。未来应重点关注高危儿童中铜绿假单胞菌血症的预防和治疗。
