title: Antibiotic-resistant bacteria and infection in children with cerebral palsy requiring mechanical ventilation.
abstract: BACKGROUND
  Severe and chronic illness can alter the bacterial flora carried in the oropharynx and gut. There are little data on the bacterial flora of children with chronic neurologic impairment.
  
  
  OBJECTIVE
  To assess carriage of abnormal bacterial flora, antibiotic-resistant bacteria, infection, and mortality in children with cerebral palsy (CP) admitted for pediatric intensive care.
  
  
  METHODS
  Prospective observational single center cohort study.
  
  
  METHODS
  Twenty-bed regional pediatric intensive care unit (PICU) in a university-affiliated tertiary referral children's hospital.
  
  
  METHODS
  All children with an established diagnosis of CP admitted to PICU and ventilated for four or more days during a 6-yr period.
  
  
  METHODS
  Surveillance samples of throat and rectum were taken at admission to PICU and twice a week thereafter. Diagnostic samples were obtained on clinical indication.
  
  
  RESULTS
  Fifty-three children with a total of 77 admissions were included. Most (90%) of the children with CP had moderate to severe functional limitations. Eighty-nine percent of the children with CP (47/53) carried abnormal bacterial flora/potential pathogens, most frequently Pseudomonas and Klebsiella species. Forty-seven percent (22/47) had antibiotic-resistant bacteria. Thirty-five children (66%) developed 86 infections during their PICU admission. Lower airways and blood were the two most commonly infected sites-Pseudomonas aeruginosa and coagulase-negative Staphylococci, the predominant infecting microorganisms. Sixty-five percent (56/86) of infections were primary endogenous infections, 21% (18/86) exogenous, and 9% (8/86) secondary endogenous. Carriage of abnormal bacterial flora, antibiotic-resistant bacteria, and infection rate was significantly higher than that of children of comparative age without CP ventilated for four or more days on PICU. Nine (17%) of the children with CP died in PICU and 4 of the deaths were infection related.
  
  
  CONCLUSIONS
  In children with moderate to severe chronic neurologic impairment admitted to PICU, there is a high rate of carriage of abnormal bacteria/potential pathogens, antibiotic-resistant bacteria, and infection.
authors.affiliation: Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital, Alder Hey, UK. kent.thorburn@alderhey.nhs.uk
authors.forename: Kentigern
authors.initials: K
authors.lastname: Thorburn
authors.forename: Michelle
authors.initials: M
authors.lastname: Jardine
authors.forename: Nia
authors.initials: N
authors.lastname: Taylor
authors.forename: Nicola
authors.initials: N
authors.lastname: Reilly
authors.forename: Richard E
authors.initials: RE
authors.lastname: Sarginson
authors.forename: Hendrick K F
authors.initials: HK
authors.lastname: van Saene
mesh_terms: D000293:Adolescent; D001424:Bacterial Infections / Q000150:complications* / Q000382:microbiology; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D004352:Drug Resistance, Microbial; D006801:Humans; D015278:Intensive Care Units, Pediatric; D011446:Prospective Studies; D012121:Respiration, Artificial