Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Dec;58(12):3507-3515.
doi: 10.1002/ppul.26684. Epub 2023 Sep 13.

Microbiological patterns of bacterial infections in tracheostomized children: Reducing uncertainty in continuous care

Miguel García-Boyano  1 , Francisco José Climent Alcalá  2 , Aroa Rodríguez Alonso  2 , Marta García Fernández de Villalta  2 , Oihane Zubiaur Alonso  2 , Ignacio Rabanal Retolaza  3 , Inmaculada Quiles Melero  4 , Cristina Calvo  1   5   6 , Luis Escosa García  2   5   6
Affiliations

Microbiological patterns of bacterial infections in tracheostomized children: Reducing uncertainty in continuous care

Miguel García-Boyano et al. Pediatr Pulmonol. 2023 Dec.

Abstract

Background and objectives: Respiratory infections are the most frequent cause of hospitalization in tracheostomized children. However, there is a lack of publications to guide their management. The primary objective was to describe the microbiological isolates and their antibiotic susceptibilities of bacterial respiratory infections in a population of tracheostomized children.

Methods: Retrospective follow-up study of children with tracheostomy seen at a tertiary hospital. Respiratory infection episodes in patients under 18 years of age who had a tracheostomy and bacterial isolation with a count ≥104 Colony Forming Units/mL in tracheal aspirate were included.

Results: The study analyzed 328 respiratory infection episodes: 164 tracheobronchitis (50%), 112 nonspecific respiratory episodes (34.1%), and 52 pneumonias (15.9%). The most commonly isolated microorganisms were Pseudomonas aeruginosa, Serratia marcescens, and Staphylococcus aureus. The antibiotics that exhibited the highest effectiveness were meropenem (92%), imipenem (87%), and levofloxacin (86%). When hospitalization exceeded 7 days, there was a higher chance of isolating Escherichia coli and Klebsiella pneumoniae (p < 0.001 and p = 0.001, respectively), as well as an increased rate of multidrug resistance (27% vs. 7%, p = 0.035). In 75.3% of cases, the microorganism had been previously isolated in a sample taken 7-30 days before the current one, with a higher frequency observed in the case of P. aeruginosa (95.2%) compared to other microorganisms (65.3%, p < 0.001).

Conclusions: Meropenem, imipenem, and levofloxacin provided the most effective coverage for these infections. The risk of multidrug resistance increased with longer hospital stays, especially for E. coli and K. pneumoniae. Recent isolation of P. aeruginosa may justify empirical coverage.

Keywords: microbiology; respiratory tract infections; tracheobronchitis; tracheostomy.

PubMed Disclaimer

References

REFERENCES

    1. Burke RT, Alverson B. Impact of children with medically complex conditions. Pediatrics. 2010;126:789-790.
    1. Bjur KA, Wi CI, Ryu E, Crow SS, King KS, Juhn YJ. Epidemiology of children with multiple complex chronic conditions in a mixed urban-rural US community. Hospital Pediatrics. 2019;9:281-290.
    1. Simon TD, Berry J, Feudtner C, et al. Children with complex chronic conditions in inpatient hospital settings in the United States. Pediatrics. 2010;126:647-655.
    1. Russell CJ, Thurm C, Hall M, Simon TD, Neely MN, Berry JG. Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy. Pediatr Pulmonol. 2018;53:349-357.
    1. Wagh A, Sinha A. Prevention of healthcare-associated infections in paediatric intensive care unit. Childs Nerv Syst. 2018;34:1865-1870.

Grants and funding