Research Article Prevalence, Clinical Features, and Outcome of Pseudomonas Bacteremia in Under-Five Diarrheal Children in Bangladesh Farhana Akram, 1 Mark A.C. Pietroni, 2 Pradip Kumar Bardhan, 3 Samira Bibi, 1 and Mohammod Jobayer Chisti 3,4 1 Pharmacy Department, East West University, Dhaka, Bangladesh 2 Public Health for South Gloucestershire, South Gloucestershire, Badminton Road, Yate, BS37 5AF, UK 3 Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh 4 Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh Correspondence should be addressed to Mohammod Jobayer Chisti; chisti@icddrb.org Received 16 December 2013; Accepted 5 February 2014; Published 9 March 2014 Academic Editors: P. Di Martino, A. Hamood, and S. J. Suh Copyright © 2014 Farhana Akram et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We sought to evaluate the prevalence, associated factors, and outcome of under-ive diarrheal children with either sex having Pseudomonas bacteremia. A retrospective chart review of under-ive diarrheal children admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 2011 to December 2011 was performed using an online hospital management system. Children with Pseudomonas bacteremia constituted the cases (n = 31), and the controls (n = 124), without Pseudomonas bacteremia, were randomly selected. he prevalence of Pseudomonas bacteremia was 1% (31/5,179). he Pseudomonas was multidrug resistant but was 84% sensitive to cetazidime and 100% to imipenem. he case-fatality rate was signiicantly higher among the cases than the controls (26% versus 5%; P = 0.003). In logistic regression analysis, ater adjusting for potential confounders such as severe wasting, severe underweight, severe pneumonia, and young age (11.71 (4.0, 18.0) months), the cases more oten presented with absent peripheral pulses in absence of dehydration (95% CI = 2.31–24.45) on admission. his inding underscores the importance of early identiication of this simple clinical sign to ensure prompt management including luid resuscitation and broad spectrum antibiotics to help reduce morbidity and mortality in such children, especially in resource-poor settings. 1. Introduction Sepsis remains a leading cause of morbidity as well as mor- tality in the pediatric population [1–5]. Most of these deaths occur in developing countries [6–8]. Pseudomonas, a facul- tative anaerobe Gram-negative organism that is commonly discovered in soil, water, and plants, seldom causes illness in healthy people. However, Pseudomonas sepsis oten occurs in patients with burns, malignancy, or immunodeiciency or in preterm infants. Most of these infections are nosocomially acquired [9, 10]. Pseudomonas infection is clinically indistin- guishable from other forms of Gram-negative bacterial infec- tion. For this reason, patients with Pseudomonas infection oten receive empirical antibiotics that are not suiciently active against Pseudomonas, especially before culture results and antibiotic sensitivities become available [11–13]. Despite recent improvements in therapy, Pseudomonas bacteremia remains fatal in more than 20% of cases [14]. In a recent large multicentre study of all age groups, Pseudomonas blood- stream infection (BSI) was multidrug resistant (MDR) and associated with crude mortality rates of 39% in all patients and 48% in intensive care unit patients [15]. Mortality is even higher when children with Pseudomonas bacteremia also have diarrhea [16]. hus, children with Pseudomonas bac- teremia and diarrhea need careful attention. An understand- ing of the factors associated with Pseudomonas bacteremia Hindawi Publishing Corporation ISRN Microbiology Volume 2014, Article ID 469758, 5 pages http://dx.doi.org/10.1155/2014/469758