Pseudomonas aeruginosa infection in respiratory samples in children with neurodisability—to treat or not to treat?

Abstract

The objective was to investigate the prevalence of Pseudomonas aeruginosa (PA) in patients with complex neurodisability and current treatment practice in our centre in order to inform future guidelines. A retrospective case note review was undertaken at a tertiary children’s hospital. One hundred sixty-two patients (mean age 11.7 years) with a primary diagnosis of neuromuscular disease (NMD) or severe cerebral palsy (CP) and a respiratory sample sent for analysis during the study period were studied. Associations between PA in respiratory samples and diagnosis, long-term ventilation, presence of a gastrostomy or a tracheostomy, antibiotic choice, clinical deterioration and adverse events were analysed. Twenty-five (15%) had one or more PA isolate in respiratory samples. There was a significant association between PA in respiratory samples and tracheostomy (p<0.05). In 52% samples, multiple pathogens co-existed. There was no significant association between choice of antibiotic and clinical outcome but when antibiotics were changed to specific PA antibiotics during the course of the illness, all resulted in clinical improvement. Twenty-six episodes involving 8 patients with recurrent admissions involved PA organisms that were resistant to one or more antibiotics.Conclusions: A larger prospective study may establish clearer criteria for guideline development. Techniques such as point-of-care testing to identify virulent strains of PA may improve patient outcomes and prevent the development of antibiotic resistance in the future. What is Known:•Children with complex neurodisability are at increased risk of respiratory morbidity and of infection with gram-negative organisms such as Pseudomonas aeruginosa.•There are currently no guidelines to inform treatment choices in this group of vulnerable children. What is New:•15% children in this study population had Pseudomonas aeruginosa in respiratory samples during a 12-month period, the majority of whom did not require critical care treatment. Thirteen of these children had a tracheostomy in situ and 12 did not. •In those that deteriorated clinically or developed antibiotic resistant organisms, earlier detection and targeted treatment of Pseudomonas aeruginosa may have prevented deterioration.

An observational study of Pseudomonas aeruginosa in adult long-term ventilation

“…Our key findings are that Pa colonisation is frequent in adults on LTV, affecting nearly 1 in 5 (17.6%). Consistent with previous data [ 7 ], we found that tracheostomy is a significant factor influencing Pa positive culture. Patients with CF and bronchiectasis also had high Pa culture rates, an expected result as this pathogen is associated with these diseases.…”

“…The frequency of Pa in the tracheostomy population was 71.7%, a higher rate than documented in previous paediatric studies [ 7 ]. Consistent with previous data [ 7 ], we also observed high rates of Pa in the cohort with cerebral palsy, but these results were not significant. This likely reflects the small sample size in this group (19).…”

“…Pseudomonas aeruginosa is a ubiquitous organism found in the natural environment but is frequently associated with both acute and chronic infections of the respiratory tract [ 6 ]. Recent paediatric research suggested a 15% prevalence of Pa in children with complex neuromuscular disorders and cerebral palsy [ 7 ]. The pathogen colonised 11% of a paediatric LTV cohort and reached a prevalence of 63% in LTV paediatric patients with a tracheostomy [ 7 ].…”

“…Recent paediatric research suggested a 15% prevalence of Pa in children with complex neuromuscular disorders and cerebral palsy [ 7 ]. The pathogen colonised 11% of a paediatric LTV cohort and reached a prevalence of 63% in LTV paediatric patients with a tracheostomy [ 7 ].…”

“…The clinical rationale for commencing antibiotic treatment in our cohort was not analysed, nor was exacerbation rate secondary to Pa infection, or the prevalence of Pa -associated pneumonia. A recent paediatric series [ 7 ] showed there was no immediate treatment benefit to acute anti-pseudomonals versus empirical antibiotics, highlighting the need for further research and understanding in this area.…”