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
Centro de Salud Canillejas, Pediatría, Madrid, Spain.
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.
J Hosp Infect. 2024 Jul;149:56-64. doi: 10.1016/j.jhin.2024.03.022. Epub 2024 May 10.
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.
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.
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).
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.
铜绿假单胞菌血流感染（PA-BSIs）是一种严重疾病，由于对碳青霉烯类药物的耐药性不断增加，它也是一个治疗难题。我们的目标是描述PA-BSI患儿中碳青霉烯类耐药（CR）和死亡率的患病率及相关危险因素。
开展了一项回顾性多中心研究，纳入2010年至2020年期间西班牙马德里四家三级医院中年龄小于20岁的PA-BSI患者。在多变量逻辑回归模型中评估CR PA-BSIs和30天死亡率的危险因素。
共纳入151例PA-BSI患者，中位年龄为29个月（四分位间距：3.5-87.1）。45例（29.8%）为CR，9.9%为多重耐药，6.6%为广泛耐药。在整个研究期间，CR的患病率保持稳定，26.7%（12/45）的CR由VIM型碳青霉烯酶介导。与碳青霉烯类敏感的铜绿假单胞菌引起的BSIs相比，CR-PA引起的BSIs患者更有可能接受不恰当的经验性治疗（53.3%对5.7%，P<0.001），且之前更有可能被CR-PA定植（8.9%对0%，P=0.002）。CR与前一个月接受碳青霉烯类治疗（调整后的优势比（aOR）11.15）和实体器官移植（aOR 7.64）相关。30天死亡率为23.2%，这与机械通气（aOR 4.24）、脓毒症（aOR 5.72）、不恰当的经验性抗生素治疗（aOR 5.86）以及作为保护因素的源头控制（aOR 0.16）相关。
本研究显示PA-BSI患儿中CR的患病率令人担忧，导致高死亡率。不恰当的经验性治疗和脓毒症与死亡率相关。应密切监测CR的高患病率以及不恰当经验性治疗风险增加的情况。
