Community-acquired Pseudomonas aeruginosa sepsis in previously healthy infants and children: analysis of forty-three episodes.

BACKGROUND: Pseudomonas aeruginosa sepsis is often considered to be hospital-acquired and to affect mainly children with underlying problems. Fewer than 50 cases of community-acquired sepsis associated with P. aeruginosa in previously healthy infants and children have been reported in English language literature.
METHODS: We retrospectively reviewed the medical records of 121 infants and children younger than 15 years of age who had 124 episodes of P. aeruginosa sepsis and were hospitalized at Chang Gung Memorial Hospital and Chang Gung Children's Hospital during 1983 and 1998. Forty-three episodes of community-acquired infection occurring in previously healthy children were evaluable for this study.
RESULTS: Thirty-two children (74%) were male and 36 (84%) were <1 year of age. Ten patients (23%) died. The onset of P. aeruginosa sepsis occurred during May to October in 34 cases (79%). Fever (91%) and diarrhea (72%) were the 2 most common initial symptoms. On admission leukopenia (leukocyte count <5,000/mm ) was present in 24 cases (57%) and in 9 of 10 fatal cases. P. aeruginosa was also isolated from other sites than bloodstream in 25 cases (58%), including 10 (43%) of 23 fecal specimens. The initial antibiotic regimen was inappropriate in 16 cases (38%), and the rate of inappropriate initial antibiotic regimen was significantly higher (P = 0.002) in fatal cases (90%) than that in nonfatal cases (24%).
CONCLUSION: Community-acquired P. aeruginosa sepsis in previously healthy infants is not rare in Taiwan. During warm weather seasons, in infants with fever and diarrhea who suddenly develop a septic appearance, it is advisable to cover for P. aeruginosa sepsis with aminoglycosides and/or anti-Pseudomonas beta-lactam antibiotics.