Pediatric tracheostomy: epidemiology and characterization of tracheal secretion - a literature review

Abstract

SUMMARY INTRODUCTION Despite the benefits, tracheostomized children are susceptible to respiratory infections, since the tube is located in a strategic region where there is colonization by several bacteria and biofilm formation. Biofilm is formed when the bacteria adhere strongly to the surfaces of the tubes, providing protection against various types of aggression, such as antibiotic treatment. OBJECTIVE To carry out a literature review of the last ten years on tracheostomized pediatric patients, in order to characterize the bacteria isolated in children’s tracheal secretions, and verify which ones are the most frequent. METHODS Two authors searched the Lilacs, SciELO, Medline Plus, and PubMed databases. The MeSH terms used were: ‘tracheostomy’ and ‘tracheotomy’ associated with ‘infections’, ‘children’, ‘child’, and ‘bacterial’ as qualifiers. RESULTS Of the 512 studies on the subject, 19 were selected for review. The total number of children evaluated in the studies was 4,472, with a mean age of 7.5 years. As for the bacteria found in the secretions of tracheostomized children, 12 species of bacteria were more frequent, P. aeruginosa was the predominant bacterium, followed by S. aureus (63.1%), Klebsiella pneumoniae (57.8%), Streptococcus pneumoniae (47.3%), and Stenotrophomonas maltophilia (47.3%). CONCLUSION One of the main complications treated in tracheostomized patients were infections, since the respiratory system is colonized by several bacteria that can cause serious infections, which are associated with the formation of biofilms. The predominant bacterium in most of the studies was P. aeruginosa, and the second species commonly reported was S. aureus.

Biofilm Formation among Stenotrophomonas maltophilia Isolates Has Clinical Relevance: The ANSELM Prospective Multicenter Study

“…We revealed a significant association between strong biofilm formation and mechanical ventilation. This is concordant with previous studies indicating that S. maltophilia causes ventilator-acquired pneumonia with a mortality rate of up to 15% [37], probably related to the bacterium's ability to grow as a biofilm on the surfaces of endotracheal tubes and tracheostomy cannula [38,39]. Further studies are warranted to evaluate whether an augmented biofilm production is expected to correlate also with the presence of other types of indwelling medical devices, such as urinary catheters and CVC.…”

Indications and Complications of Tracheostomy in Pediatric Age group in Hilla, Babylon province, Iraq: Cross sectional Study

“…The procedure tracheostomy involves making an opening in the airways and introduction of tube into tracheal rings in order to bypass obstruction and allowing air to reach the lungs 1 . Since ancient times, tracheostomy practice has been reported.…”

“…Ancient Egyptians had made painting describing this procedure, thereby it can be said that the procedure is known for more than 2000 years 2 . Since infections of the upper respiratory tract, including diphtheria, represented by far the major reason for tracheostomy, great changes have been undertaken in the indications for tracheostomy between the 1980s until around 1995 1 . Adoption of well organized and systemized immunization programs has made changes in the profile of infection worldwide, thus, the need for tracheostomy in the setting of upper respiratory tract infection have been reduced 3 .…”

“…Nowadays, the most frequent reasons for tracheostomy performance are "acute respiratory failure, prolonged intubation, neurological disorders or lesions" 1 . The survival of neonates and children witnessed substantial improvement following implementation of such procedure, therefore, the rate of performing tracheostomy in children has become high 1,2,4 . It should be kept in mind that the hazard of infection is significantly more in children with tracheostomy.…”

“…Among common infectious complications accompanying tracheostomy are bacterial tracheitis, aspiration pneumonia and bacterial pneumonia, the later being the most commonly reported in pediatric practice and responsible for significant hospitalization (8). Among micro-organism isolated commonly from tracheostomy cannula, are Pseudomonas aeruginosa and Staphylococcus aureus 1,9 . Little information is available about complications of tracheostomy in Hilla general teaching hospital.…”