• Kentigern Thorburn, Michelle Jardine, Nia Taylor, Nicola Reilly, Richard E Sarginson, and Hendrick K F van Saene.
• Department of Paediatric Intensive Care, Royal Liverpool Children's Hospital, Alder Hey, UK. kent.thorburn@alderhey.nhs.uk
• Pediatr Crit Care Me. 2009 Mar 1;10(2):222-6.

IntroductionSevere 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.ObjectivesTo assess carriage of abnormal bacterial flora, antibiotic-resistant bacteria, infection, and mortality in children with cerebral palsy (CP) admitted for pediatric intensive care.DesignProspective observational single center cohort study.SettingTwenty-bed regional pediatric intensive care unit (PICU) in a university-affiliated tertiary referral children's hospital.PatientsAll children with an established diagnosis of CP admitted to PICU and ventilated for four or more days during a 6-yr period.MeasurementsSurveillance samples of throat and rectum were taken at admission to PICU and twice a week thereafter. Diagnostic samples were obtained on clinical indication.Main ResultsFifty-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.ConclusionsIn 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.

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