Pseudomonas aeruginosa bacteraemia in an academic hospital in South Africa

Abstract

This study aimed at determining the clinical manifestations, outcome and prognostic factors associated with P. aeruginosa bacteraemia at the Chris Hani Baragwanath Hospital during the period 1998-99; to describe and quantify resistance to anti-pseudomonal drugs, and characterization of bacteraemic isolates, investigate the genetic relationship among drug susceptible and multiply resistant strains in the hospital.
Clinical and laboratory investigations, culture and antimicrobial susceptibility testing were performed. Bacteraemic isolates were typed by endonuclease macrorestriction. Those with ≥97% band pattern similarity were assigned genotype status. Of 91 P. aeruginosa blood isolates, 52 (57%) were nosocomially acquired. Underlying conditions associated with episodes were burns in 24 (26.4%) and HIV infection in 21 (23%). Multi-drug resistance was present in 14 isolates (15.4%). Outcome was poor and death was associated with 36 (45.56%) of episodes. Case fatality rates were 60% in adults and 27.3% in children. Being a child, receiving appropriate antimicrobial treatment and admission to specialized care units were significantly associated with improved prognosis.
P. aeruginosa bacteraemia was associated with outbreaks caused by two multiply resistant genotypes. Eighteen, antimicrobial susceptible isolates from bacteraemic episodes in paediatric wards, 9 in HIV-seropositive children, could be linked to small outbreaks in both hospitalised and community-based children.