Gerdung Christopher A, Tsang Adrian, Yasseen Abdool S, Armstrong Kathleen, McMillan Hugh J, Kovesi Thomas
Alberta Children's Hospital, Calgary, Alberta, Canada.
University of Ottawa, Ottawa, Ontario, Canada.
Lung. 2016 Apr;194(2):307-14. doi: 10.1007/s00408-016-9856-5. Epub 2016 Feb 16.
Children with cerebral palsy (CP) are at an increased risk for aspiration, and subsequent pneumonia or pneumonitis. Pneumonia is a common cause of hospital admission, intensive care unit (ICU) admission, and death in patients with CP, and may disproportionately contribute to mortality. The role of respiratory microflora is unknown. This study examined the relationship between respiratory infections with Gram-negative bacteria (GNB), particularly Pseudomonas aeruginosa, and the frequency/severity of pneumonia hospitalization.
Retrospective chart review of 69 patients with CP and hospitalization for pneumonia. Eligible patients required hospitalization for bacterial pneumonia, at least one respiratory culture, and fulfillment of Bax definition of CP. Group assignment was based on respiratory culture. Charts were analyzed for comorbid illness, hospitalization demographics, and disease severity.
Children with isolation of P. aeruginosa or other GNB had increased frequency of ICU admission (77.4, 65.1, vs. 26.9 %, respectively, p < 0.01), intubation (45.2, 39.5 vs. 11.5 %, p = 0.02, p = 0.03 respectively), and large pleural effusions (37.5, vs. 0 %) than children without GNB. Children with isolation of GNB had more prolonged hospitalizations and were more likely to have multiple hospitalizations than those without GNB.
Colonization with P. aeruginosa and other Gram-negative organisms in children with CP is associated with increased morbidity, prolonged hospitalization, and severity of pneumonia including need for PICU admission and intervention. Further research is required to determine causality, the role of antimicrobials active against Gram negative in pneumonia treatment, and the role of GNB eradication therapy in children with CP.
脑瘫（CP）患儿发生误吸及随后发生肺炎或肺炎性疾病的风险增加。肺炎是CP患者住院、入住重症监护病房（ICU）及死亡的常见原因，且可能在死亡率中占比过高。呼吸道微生物群的作用尚不清楚。本研究探讨了革兰氏阴性菌（GNB）尤其是铜绿假单胞菌引起的呼吸道感染与肺炎住院频率/严重程度之间的关系。
对69例CP患儿因肺炎住院的病历进行回顾性分析。符合条件的患者需因细菌性肺炎住院、至少进行一次呼吸道培养，并符合Bax对CP的定义。根据呼吸道培养结果进行分组。分析病历中的合并症、住院人口统计学资料及疾病严重程度。
分离出铜绿假单胞菌或其他GNB的患儿入住ICU的频率（分别为77.4%、65.1%， vs. 26.9%，p<0.01）、插管率（分别为45.2%、39.5% vs. 11.5%，p = 0.02，p = 0.03）及大量胸腔积液发生率（37.5%， vs. 0%）均高于未分离出GNB的患儿。分离出GNB的患儿住院时间更长，且比未分离出GNB的患儿更易多次住院。
CP患儿感染铜绿假单胞菌和其他革兰氏阴性菌与发病率增加、住院时间延长及肺炎严重程度增加有关，包括需要入住儿科重症监护病房及进行干预。需要进一步研究以确定因果关系、抗革兰氏阴性菌药物在肺炎治疗中的作用以及GNB根除治疗在CP患儿中的作用。
