title: Association Between Chronic Aspiration and Chronic Airway Infection with Pseudomonas aeruginosa and Other Gram-Negative Bacteria in Children with Cerebral Palsy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Alberta Children's Hospital, Calgary, Alberta, Canada. Drchristophergerdung@gmail.com.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Gerdung
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Adrian
authors.initials: A
authors.lastname: Tsang
authors.affiliation: Children's Hospital of Eastern Ontario, Research Institute, Ottawa, Ontario, Canada.
authors.forename: Abdool S
authors.initials: AS
authors.lastname: Yasseen
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.|Children's Hospital of Eastern Ontario, Research Institute, Ottawa, Ontario, Canada.
authors.forename: Hugh J
authors.initials: HJ
authors.lastname: McMillan
authors.affiliation: University of Ottawa, Ottawa, Ontario, Canada.|Children's Hospital of Eastern Ontario, Research Institute, Ottawa, Ontario, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kovesi
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002547:Cerebral Palsy / Q000150:complications* / Q000175:diagnosis; D002648:Child; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D010343:Patient Admission; D011015:Pneumonia, Aspiration / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D063466:Respiratory Aspiration of Gastric Contents / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Cerebral palsy; Intensive care; Pediatric; Pneumonia; Pseudomonas