Community-acquired Pseudomonas aeruginosa pneumonia in immunocompetent children: a study of 7 cases

Background To characterize the clinical features and outcomes of community-acquired Pseudomonas aeruginosa (PA) pneumonia in immunocompetent children. Methods A retrospective analysis was conducted of the detailed clinical data from seven cases of community-acquired PA pneumonia in immunocompetent children, who were hospitalized in the Department of Pediatrics at the First Affiliated Hospital of Guangxi Medical University between January 2015 to June 2025. Results All patients were male (n = 7). Age distribution was as follows: 1–12 months (n = 3), 13–36 months (n = 1), 37–60 months (n = 1), and ≥ 61 months (n = 2). Median age at onset was 18.0 months (IQR: 8.0–123.0). All patients presented acutely with fever and cough; two developed respiratory failure within 72 hours. Additional clinical features included dyspnea (n = 4), lung rales (n = 4), hemoptysis (n = 3), chest pain (n = 2), and wheezing (n = 1). Chest imaging showed lobar consolidation (n = 5) or mass-like consolidation (n = 2). PA was cultured from five patients. All isolates were susceptible to anti-pseudomonal β-lactam antibiotics except aztreonam. Complications included definite or suspected empyema (n = 5), pyopneumothorax (n = 3), and bacteremia (n = 2). Three patients required pediatric intensive care, two received invasive mechanical ventilation, two underwent closed thoracic drainage, and one required decortication. There were no deaths, but four patients sustained significant pulmonary damage. Conclusion Although rare, community-acquired PA pneumonia in immunocompetent children is associated with severe disease and pulmonary complications. Initial therapy with anti-pseudomonal β-lactam antibiotics appears effective in improving outcomes.