Pseudomonas aeruginosa eradication in paediatric non-CF bronchiectasis; A retrospective study

Abstract

Introduction/Aim: Bronchiectasis in children is an increasingly recognised condition but there is paucity of evidence to guide management, with many treatment recommendations extrapolated from adults with bronchiectasis and/or CF data. There are no published studies on P. aeruginosa (Pa) management in children with non-CF bronchiectasis. We aimed to evaluate our centre's practice and determine if outcomes are associated with the treatment received. Methods: Data was retrospectively collected from children who had CT evidence of bronchiectasis and a positive lower respiratory tract culture for Pa between 2014 and 2019, identified via electronic medical records. We divided the cohort into those who received 'ideal' management (in accordance with the 2021 European Respiratory Society (ERS) guidelines) and those who did not. Our primary outcome was microbiological clearance of Pa at 12- and 24-months post treatment; secondary outcomes were differences in growth, lung function and pulmonary exacerbations in the treatment groups, plus clinical predictors of non-clearance. Results: Twenty-seven patients were identified: 12 received dual anti-pseudomonal intravenous antibiotics for 2 weeks followed by at least 4 weeks of nebulised tobramycin (Ideal management) and 15 had other Pa -targeted treatment. Pa clearance was higher in ideally managed versus other treatment group at 12 months (5/7 (71%) vs. 6/13 (46%), p = 0.37), but not at 24 months (3/7 (43%) vs. 6/9 (67%), p = 0.61) among those with available samples. Lower baseline BMI predicted persisting Pa infection at 12 months (BMI z-score -1.05 vs. 0.54, p = 0.01), but not at 24 months. Conclusion: There is variation in the treatment of first isolation of Pa in our centre. There is a trend towards improved microbiological clearance of Pa at 12 months but not at 24 months when managed as per 2021 ERS guidelines, but much larger sample sizes are needed to determine the optimal treatment for Pa clearance.