Pseudomonas Aeruginosa Infection in Respiratory Samples in Children with Neurodisability – to treat or not to treat?

Children with complex neurodisability have increased risk of respiratory tract infections. Pseudomonas aeruginosa (PA) is an organism that commonly infects and colonises the airway. Treatment choices are complicated by adverse effects and development of antibiotic resistant organisms. There are no established guidelines and the treatment approach of clinicians varies. A retrospective case notes review was undertaken to look at the prevalence of PA in respiratory samples of children with neurodisability, treatment practices and outcomes. Of 226 children with a neuromuscular condition or cerebral palsy (GMFCS score 4-5), 25 had at least one PA positive sample during a 12-month period. Those using a tracheostomy were twice as likely to isolate PA; 21 (80%) had recurrent isolates, suggesting colonisation of the airway. 62 individual clinical episodes were identified. Patients most likely to deteriorate clinically were those treated with broad-spectrum antibiotics (41%) compared with PA-specific (27%) or no antibiotics (11%). All 10 patients in whom antibiotics were changed as directed by microbial results, improved clinically thereafter. No adverse effects were documented as a direct result of antibiotics. Antibiotic resistance was documented in 8/21 colonised patients with these more likely to require escalation to intensive care treatment. A guideline for management and more sophisticated methods to direct treatment choices are needed. Techniques such as the ability to identify virulent strains of PA using point-of-care testing may improve patient outcomes and prevent the development of antibiotic resistance in the future.