Background Pseudomonas aeruginosa ( P. aeruginosa ) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. Methods From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. 52 case were analyzed. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. Results Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs 12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The study also revealed that the independent risk factors for septic shock were as follows: TTP≤18h, Pitt bacteremia scores≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively). Conclusions Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.

Background: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia.Methods: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock.Results: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively).Conclusions: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.Trial registration: Retrospectively registered. File No. (2019)304

We aim to evaluate the effects of time to appropriate therapy (TTAT) on outcomes in children with nosocomial K. pneumoniae bloodstream infection, and to find an optimal time window for empiric antibiotics administration. Children with nosocomial K. pneumoniae bloodstream infection hospitalized in Children’s Hospital of Chongqing Medical University from April 2014 to December 2019 were enrolled retrospectively. TTAT cutoff point and risk factors were determined and analyzed by Classification and Regression Tree (CART) analysis and Logistic Regression analysis. Overall, sixty-seven patients were enrolled. The incidence of septic shock and mortality was 17.91% (12/67) and 13.43% (9/67), respectively. The CART-derived TTAT cutoff point was 10.7 hours. The multivariate logistic regression analysis indicated delayed therapy (TTAT ≥ 10.7 h), PRISM III scores ≥ 10, early TTP (TTP ≤ 13 h), and need for invasive mechanical ventilation were independent risk factors of septic shock (OR 9.87, 95% CI 1.46-66.59, P = 0.019; OR 9.69, 95% CI 1.15-81.39, P = 0.036; OR 8.28, 95% CI 1.37-50.10, P = 0.021; OR 6.52, 95% CI 1.08-39.51, P = 0.042; respectively) and in-hospital mortality (OR 22.19, 95% CI 1.25-393.94, P = 0.035; OR 40.06, 95% CI 2.32-691.35, P = 0.011; OR 22.60, 95% CI 1.78-287.27, P = 0.016; OR 12.21, 95% CI 1.06-140.67, P = 0.045; respectively). Conclusions: TTAT is an independent predictor of poor outcome in children with nosocomial K. pneumoniae bloodstream infection. Initial appropriate antibiotic therapy should begin within 10.7 hours from the onset of bloodstream infection.

Background Pseudomonas aeruginosa ( P. aeruginosa ) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia.Methods From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. 52 case were analyzed. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and sepsis shock.Results Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of sepsis shock (52.4% vs 12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The study also revealed that the independent risk factors for sepsis shock were as follows: TTP≤18h, Pitt bacteremia scores≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively).Conclusions Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.