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Pseudomonas aeruginosa (Pa) is a leading cause of lung infection in patients with cystic fibrosis (CF), increasing morbidity and mortality. Despite this, there is no standardized treatment among the medical community for Pa eradication in patients with CF. The Nebraska Regional Cystic Fibrosis Center at Children’s Hospital and Medical Center (CHMC) in Omaha, Nebraska has a Pa eradication protocol. This study aims to increase Pa eradication for children with CF by investigating the effectiveness and adherence to the current Pa eradication protocol.
This study is a retrospective medical chart review of 1–21-year-olds with CF receiving care at CHMC. Medical records for each patient were screened for Pa culture results and Pa treatments. Primary endpoints were the degree of protocol adherence, eradication success, and subsequent colonization following CHMC’s Pa eradication protocol. The current protocol starts patients on step one with inhaled tobramycin for 28 days and oral ciprofloxacin for 14 days following a positive Pa culture. If still positive after that time, they are started on step two with 10-14 days of intravenous antibiotics. If sustained positivity following IV antibiotics, they progress to step three with six months of alternating monthly inhaled tobramycin, colistin, or aztreonam. If positivity after step three, they are considered colonized. If they have a negative sputum culture following any step, Pa is considered eradicated, they continue quarterly monitoring, and restart the protocol following another positive Pa result.
Of the 184 CHMC’s CF patients, 172 patients were used for the study (8 excluded for age and 4 for inadequate medical records). For those included, the protocol was fully followed correctly for 70.3% (N=121) of patients. When step one of the protocol was followed, 151/206 (73.3%) of treatments had Pa eradication compared to 36/61 (59.0%) of patients with non-protocol treatment (OR 0.52, 95% CI 0.29-0.95, P=0.03). However, there was no statistically significant difference in eradication when comparing steps two and three to non-protocol treatments. When the complete protocol was followed, 12/121 (9.9%) of patients became chronically colonized with Pa compared to 27/51 (52.9%) of patients who did not follow protocol guidelines (OR 0.099, 95% CI 0.04-0.22, P-value= <0.0001).
Adherence to the CHMC’s current protocol is associated with increased Pa eradication levels when used at step one and decreased colonization cases. Early initiation of treatment using this protocol is vital to improving morbidity and mortality associated with Pa infections in cystic fibrosis children.
DeVries, Adam; Thomas, Heather; and Acquazzino, Diane, "Evaluation of Pseudomonas aeruginosa Eradication Protocol in Pediatric Patients with Cystic Fibrosis: A Retrospective Medical Chart Review" (2021). Child Health Research Institute Pediatric Research Forum. 6.