Pseudomonas aeruginosa urinary tract infection in children: risk factors and outcomes

Purpose: Pseudomonas aeruginosa is an unusual uropathogen that is mostly responsible for nosocomial or catheter associated urinary tract infections in adults. Data about P. aeruginosa urinary tract infections in children are scarce. We investigated P. aeruginosa urinary tract infections in children in a well-defined area.

Materials and methods: Clinical, laboratory and radiological characteristics of all children with P. aeruginosa urinary tract infections were compared to those of gender matched children with community acquired Escherichia coli urinary tract infections during a 12-year period.

Results: A total of 35 children with 43 P. aeruginosa urinary tract infection episodes representing 6.7% of total urinary tract infection cases during the study period were compared to 70 children with E. coli urinary tract infections. Children with P. aeruginosa more often presented with a history of at least 1 previous urinary tract infection episode (p <0.0001), hospitalization (p = 0.0001), use of antibiotics (p = 0.0001), malformations predisposing to urinary tract infections (p = 0.004), vesicoureteral reflux (p <0.0001), abnormal dimercapto-succinic acid scan (p = 0.0003), longer hospitalization and surgery. Use of antibiotics either as prophylaxis or as treatment within the preceding 2 months was demonstrated by multivariate logistic regression analysis as the single independent risk factor for P. aeruginosa urinary tract infections (odds ratio 21.6, 95% CI 4.65-100, p = 0.0001). P. aeruginosa isolates were often resistant to gentamicin (27.9%) and ceftazidime (13.9%) but remained sensitive to carbapenems and ciprofloxacin.

Conclusions: P. aeruginosa urinary tract infection is associated with distinct risk factors and outcomes, and should be considered in predisposed children with symptoms of urinary tract infection who are on prophylaxis or have a history of a recent course of antibiotics.