Pseudomonas Aeruginosa and Antibiotic- Associated Diarrhea in Children

Background: Antibiotics are frequently prescribed for the treatment of infectious diseases. Although antibiotic-associated diarrhea (AAD) is a common adverse event in children, few studies have investigated this issue. Objectives: To investigate the frequency, the antibiotics incriminated and the risk factors for developing Pseudomonas-associated diarrhea (PAAD) in children admitted to our hospital. Material and methods: The main anamnestic and demographic features, characteristics of diarrhea, therapeutic management, and clinical outcomes of children with PAAD were evaluated. We have considered a child diagnosed with PAAD if he had three or more stools a day of liquid consistency for at least two days from the start of antibiotic administration. Children with acute/chronic diarrhea, immunodeficiencies and no history of antibiotics before the diarrhea started were excluded. Results: Out of 55 children diagnosed with diarrhea, fifteen children (27.27%) had PAAD. The majority were infants and toddlers (66.67%). Antibiotic therapy was prescribed mainly for pulmonary infections (40%), neonatal sepsis (20%) and upper respiratory tract infections (13.33%). PAAD was associated with the use of Cephalosporins (40%), Amoxicillin/Clavulanate (15%) and Aminoglycosides (15%). The relative risk of onset of PAAD in a child receiving Cephalosporins was 1.83, respectively 1.5 when the child was younger than 2 years and 2.4 for patients admitted in intensive care units. Conclusions: The diaper-wearing group, the use of Cephalosporins and the admission to intensive care units are risk factors for PAAD. Further investigations on PAAD with larger cohort are required to confirm our results.