P. aeruginosa infection common in patients having tracheostomy, CF, and bronchiectasis
UK: Positive culture of P. aeruginosa is common within the adult long-term ventilation (LTV) population and is associated significantly with cystic fibrosis, tracheostomy, and bronchiectasis -- states research published in ERJ Open Research.
Further, the researchers report that in order to establish the prognostic impact of P. aeruginosa and to guide antimicrobial management more research and international guidelines are required. The increased risk of P. aeruginosa should be considered when contemplating long-term ventilation via tracheostomy, they note.
In respiratory disease, Pseudomonas aeruginosa increases morbidity and mortality. To date, there are no clear guidelines regarding the management of the long-term ventilation population. To fill this knowledge gap, Ruth Sobala, North East Assisted Ventilation Service, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK, and colleagues aimed to describe both the prevalence of Pa in the home ventilation cohort and the management strategies applied.
For this purpose, the researchers undertook a retrospective observational study in a regional long-term ventilation population (837 patients). The primary outcome was defined as the P. aeruginosa isolation. They also recorded positive cultures for co-pathogens (Serratia, Proteus species, Stenotrophomonas, Burkholderia cepacia complex, and nontuberculous mycobacteria) were recorded. Calculation of logistic regression and odds ratios was also done.
Based on the study, the researchers reported the following:
- 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) and cystic fibrosis/bronchiectasis (logistic regression coefficient 2.48).
- 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 nebulized antibiotic and 21.1% received both.
- Tracheostomised P. aeruginosa-positive patients received a nebulized antibiotic more frequently (OR 2.63).
- 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).
To conclude, P. aeruginosa isolation is common within the adult long-term ventilation population and is significantly associated with tracheostomy, cystic fibrosis, and bronchiectasis.
Reference:
An observational study of Pseudomonas aeruginosa in adult long-term ventilation. Ruth Sobala, Hannah Carlin, Thomas Fretwell, Sufyan Shakir, Katie Cattermole, Amy Royston, Paul McCallion, John Davison, Joanna Lumb, Hilary Tedd, Ben Messer, Anthony De Soyza. ERJ Open Research Apr 2022, 8 (2) 00687-2021; DOI: 10.1183/23120541.00687-2021
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