RT Journal Article
SR Electronic
T1 An observational study of <em>Pseudomonas aeruginosa</em> in adult long-term ventilation
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00687-2021
DO 10.1183/23120541.00687-2021
VO 8
IS 2
A1 Ruth Sobala
A1 Hannah Carlin
A1 Thomas Fretwell
A1 Sufyan Shakir
A1 Katie Cattermole
A1 Amy Royston
A1 Paul McCallion
A1 John Davison
A1 Joanna Lumb
A1 Hilary Tedd
A1 Ben Messer
A1 Anthony De Soyza
YR 2022
UL http://openres.ersjournals.com/content/8/2/00687-2021.abstract
AB Introduction Pseudomonas aeruginosa increases morbidity and mortality in respiratory disease. To date the long-term ventilation population does not have clear guidelines regarding its management.Method We undertook a retrospective observational study in a regional long-term ventilation population (837 patients). We defined the primary outcome as P. aeruginosa isolation. In addition positive cultures for copathogens (Serratia, Proteus species, Stenotrophomonas, Burkholderia cepacia complex and nontuberculous mycobacteria) were recorded. Logistic regression and odds ratios were calculated.Results 17.6% of the cohort isolated P. aeruginosa, and this pathogen was cultured more frequently in patients with a tracheostomy (logistic regression coefficient 2.90, p≤0.0001) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48, p≤0.0001). 6.3% of patients were ventilated via tracheostomy. In the P. aeruginosa positive cohort 46.9% of patients were treated with a long-term macrolide, 36.7% received a nebulised antibiotic and 21.1% received both. Tracheostomised P. aeruginosa positive patients received a nebulised antibiotic more frequently (OR 2.63, 95% CI 1.23–5.64, p=0.013). Copathogens were isolated in 33.3% of the P. aeruginosa cohort. In this cohort patients with a tracheostomy grew a copathogen more frequently than those without (OR 2.75, 95% CI 1.28–5.90).Conclusions P. aeruginosa isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Further research and international guidelines are needed to establish the prognostic impact of P. aeruginosa and to guide on antimicrobial management. The increased risk of P. aeruginosa should be considered when contemplating long-term ventilation via tracheostomy.Pseudomonas aeruginosa isolation is common (17%) in long-term ventilated adults and significantly associated with tracheostomy, cystic fibrosis and bronchiectasis. Tracheostomy patients with P. aeruginosa isolates culture copathogens more frequently. https://bit.ly/3vvxBbB