Journal Article

P41 Pseudomonas aeruginosa: burden, treatment and outcomes in a long term ventilation service

Messer, B, Davison, J, Fretwell, TB, De Soyza, A, Sobala, RE, Lumb, J, Tedd, H, McCallion, P, Cattermole, K, Carlin, HJ, Shakir, S, Royston, A

2021

Overview

IntroductionPseudomonas aeruginosa (PA) is a significant respiratory pathogen but is not well described in patients requiring long term ventilation (LTV). Whilst national guidance exists for the management of PA in the bronchiectasis population, standards for sputum surveillance and the use of nebulised antibiotics (NA) or long term macrolides (LTM) in the LTV population have not been established.Our aim was to record the rate of PA and describe its treatment, in a large cohort of LTV patients.MethodsRetrospective cohort study using the regional LTV service database to identify patients. Electronic patient records were analysed for LTV indication and treatment with NA and LTM, and cross-referenced with regional microbiology datasets: specifically, positive results for Pseudomonas, Serratia, Proteus and/or Burkholderia spp.ResultsWe identified 837 patients under the regional LTV service. 52/837 (6.2%) were ventilated via tracheostomy. 57/837 (6.8%) used a cough assist device alone and the remainder used non-invasive ventilation.Figure 1 shows prevalence of PA by diagnostic subgroup; the burden of PA in bronchiectasis and CF was high as expected, however there was also a high burden of disease in patients with spinal cord injuries and primary muscle disorders, such as Duchenne Muscular Dystrophy.Abstract P41 Figure 1Prevalence of pseudomonas aeruginosa by diagnostic subgroupOf the PA positive cohort, 45/146 (30.8%) were treated with NA: colistin (64.4%), an alternative NA (11.1%) or a combination (24.4%). 49.2% were taking long term macrolides: alone (56.2%) or combined with NA (43.7%).Commencement of NA was poorly documented, hindering assessment of PA suppression or effects on emerging pathogens. Proteus/Serratia/Burkholderia spp. were isolated in 5.1% of the LTV cohort, of which 38% were co-colonising patients with PA.ConclusionsPA is common and seen across a diverse number of LTV indications, including neuromuscular conditions not traditionally associated with high bacterial load. PA prevalence was higher in tracheostomy patients. Many patients are treated with NA but the recording of eradication rates and sputum surveillance is low. The rate of 3 sentinel emergent pathogens was low but this may reflect the low rate of sputum surveillance. This study highlights a need for further studies and development of guidance on pseudomonas in patients on LTV.

• Publisher: BMJ Publishing Group Ltd and British Thoracic Society,BMJ Publishing Group LTD
• Subject: Advances in the management of TB and NTM infections / Antibiotics / Long term / Ostomy / Pathogens / Surveillance / Tracheotomy / Ventilation