We sought to evaluate the prevalence, associated factors, and outcome of under-five diarrheal children with either sex having Pseudomonas bacteremia. A retrospective chart review of under-five 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. The prevalence of Pseudomonas bacteremia was 1% (31/5,179). The Pseudomonas was multidrug resistant but was 84% sensitive to ceftazidime and 100% to imipenem. The case-fatality rate was significantly higher among the cases than the controls (26% versus 5%; P = 0.003). In logistic regression analysis, after 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 often presented with absent peripheral pulses in absence of dehydration (95% CI = 2.31–24.45) on admission. This finding underscores the importance of early identification of this simple clinical sign to ensure prompt management including fluid 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 mortality in the pediatric population [1–5]. Most of these deaths occur in developing countries [6–8]. Pseudomonas, a facultative anaerobe Gram-negative organism that is commonly discovered in soil, water, and plants, seldom causes illness in healthy people. However, Pseudomonas sepsis often occurs in patients with burns, malignancy, or immunodeficiency or in preterm infants. Most of these infections are nosocomially acquired [9, 10]. Pseudomonas infection is clinically indistinguishable from other forms of Gram-negative bacterial infection. For this reason, patients with Pseudomonas infection often receive empirical antibiotics that are not sufficiently 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 bloodstream infection (BSI) was multidrug resistant (MDR) and associated with crude mortality rates of 39% in all patients and 48% in intensive care
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