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

Lookup NU author(s): Emeritus Professor John Davison, Dr Hilary Tedd, Professor Anthony De SoyzaORCiD

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© The authors 2022. 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.

Publication metadata

Author(s): Sobala R, Carlin H, Fretwell T, Shakir S, Cattermole K, Royston A, McCallion P, Davison J, Lumb J, Tedd H, Messer B, De Soyza A

Publication type: Article

Publication status: Published

Journal: ERJ Open Research

Year: 2022

Volume: 8

Issue: 2

Online publication date: 10/04/2022

Acceptance date: 22/02/2022

Date deposited: 06/06/2022

ISSN (electronic): 2312-0541

Publisher: European Respiratory Society

URL: https://doi.org/10.1183/23120541.00687-2021

DOI: 10.1183/23120541.00687-2021

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