Frontiers in pediatrics
Nursing care of a child with cerebral palsy and multidrug-resistant bacterial pneumonia treated with bacteriophage therapy: a case report
By Wang L, Lu C, Li H and 1 others.
Abstract
Background
Children with cerebral palsy (CP) are at high risk of pulmonary infection with multidrug-resistant organisms (MDROs) owing to recurrent infections, prolonged hospitalization, and repeated antibiotic exposure. Bacteriophage (phage) therapy has emerged as a promising alternative for infections refractory to conventional antibiotics; however, its application in children with CP complicated by multidrug-resistant pneumonia has rarely been reported, and corresponding nursing experience remains scarce.
Case presentation
This report describes the nursing care of a 2-year-and-4-month-old boy with CP, secondary epilepsy, and severe pneumonia caused by carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Klebsiella pneumoniae (CRKP), and Staphylococcus aureus (discharge diagnosis: methicillin-resistant S. aureus infection), in whom conventional antibiotic therapy had failed. After comprehensive eligibility assessment, percutaneous endoscopic gastrostomy (PEG)-based nutritional optimization, and written informed consent, the child received a pre-planned 3-day course of nebulized phage cocktail therapy. Nursing care integrated standardized phage aerosol administration, staged enteral nutritional support, and family-centered health education. After treatment, A. baumannii was eradicated from bronchoalveolar lavage fluid, and subsequent A. baumannii isolates were susceptible to imipenem and meropenem (MIC ≤ 0.25 μg/mL, versus ≥16 μg/mL before therapy); CRKP was not re-isolated, and later S. aureus isolates were oxacillin-susceptible. Body temperature normalized, peripheral oxygen saturation remained stable without supplemental oxygen, and inflammatory markers decreased markedly. Body weight increased from 13.40 kg to 14.35 kg, and the nutritional risk score (STAMP) decreased from 5 (high risk) to 3. The child was discharged after 58 days of hospitalization.