Persistent Pseudomonas Aeruginosa Infection in a child with Cystic Fibrosis – How to manage?

Lavina Desai*, Ira Shah**
* Seth G S Medical College, Mumbai, India, and **Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India.

Address for Correspondence: Lavina Desai, Seth G S Medical College, India. Email: lavinadesai16@gmail.com


Clinical Problem:
A 6 month old girl was diagnosed to have cystic fibrosis (CF) in 2009 in view of recurrent respiratory tract infections and diarrhea with malnutrition. Sweat chloride conductivity test was positive (75 mmol/L equivalent NaCl). She tested positive for both the alleles of F508 mutation. She was started on pancreatin supplements and vitamins A, D, E and K following which her diarrhea subsided. She was hospitalized for the first time in December 2011. Her sputum cultures subsequently grew Bukholderia cepacia, Streptococcus pneumoniae, Klebsiella pneumoniae and Pseudomonas aeruginosa over the next few months. She was put on tobramycin nebulization along with N-acetyl cysteine nebulization. Her sputum cultures continued to grow Pseudomonas aeruginosa on and off. In December 2013, the P. aeruginosa was resistant to tobramycin and she was treated with oral ciprofloxacin and nebulized Colistin for 6 weeks. She was alright till February 2014 when she was hospitalized with pneumonia and was treated with Amikacin and Ceftazidime for 4 weeks. In view of poor weight gain, a percutaneous endoscopic gastrostomy (PEG) tube insertion was done in April 2014. She continued to have recurrent pneumonias due to P. aeruginosa for which she was on nebulized Colistin and finally succumbed to her disease in February 2018.

How to manage persistent pseudomonas aeruginosa infection in cystic fibrosis?