Enteral antipseudomonal fluoroquinolones for ventilator‐associated tracheobronchitis in children with pre‐existing tracheostomy

Background and ObjectivesRespiratory 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.MethodsRetrospective 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.ResultsThe 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).ConclusionsMeropenem, 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.

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

García‐Boyano,

Alcalá,

Alonso

et al. 2023

“…Regarding the former, while the most common duration of inhaled antibiotics in our population was 10–14 days, there are few data available regarding the ideal duration of therapy to treat RTIs in children with tracheostomy tubes. The duration of systemic antibiotics for RTIs has been investigated in heterogeneous populations intubated with tracheostomies or endotracheal tubes; in these studies, durations longer that 7–8 days did not confer improved outcomes, 10,14,15 suggesting that the antibiotic exposures in our population may have been excessive. Regarding the utility of tracheal aspirate results, most tracheal aspirate cultures (>85%) grew bacteria, but these results did not appear to drive therapeutic choices.…”

Section: Discussionmentioning

confidence: 92%

Inhaled antibiotics in children with tracheostomy tubes: A descriptive study

Gipsman

Prero

Toltzis

et al. 2022

Introduction Respiratory tract infections (RTIs) are common in children with tracheostomy tubes. Anecdotally, inhaled antibiotics are commonly prescribed, although to date there are no studies describing their use in this patient population. The objective of this study was to assess the variability of this practice at a single tertiary care children's hospital. Methods All children admitted to our hospital with a tracheostomy tube who were prescribed inhaled antibiotics between 2013 and 2020 were included. Patient characteristics and data regarding inhaled antibiotic use were obtained retrospectively from the electronic medical record. Results A total of 424 courses of inhaled antibiotics were prescribed during the study period. 296 (69.8%) courses were prescribed to treat an acute RTI, whereas 128 (30.2%) were prescribed prophylactically to prevent RTIs. 58.9% of children with tracheostomy tubes hospitalized during the study period received at least one course of inhaled antibiotics. The most common antibiotics prescribed were tobramycin and gentamicin; several different doses were used. In 53.2% of treatment courses, inhaled antibiotics were co‐prescribed with systemic antibiotics. Therapy duration for treatment varied from 3 to 28 days. Respiratory cultures were used variably and antimicrobial susceptibility was often not taken into account when prescribing inhaled antibiotics. Conclusions Inhaled antibiotics were frequently prescribed as treatment and prophylaxis in children with tracheostomy tubes at our center, with significant variation in the prescribed antibiotic type, dose, frequency, duration, and co‐prescription with systemic antibiotics. Prospective studies are needed to define best practice regarding inhaled antibiotics in this patient population.

“…Six retrospective cohort studies looked at the use of systemic antimicrobials; these are summarized in Table 1. Of these studies, one covered initiation of antimicrobials in outpatient clinics, 32 four looked at choice of inpatient antimicrobials, 30,31,33,34 and one assessed the impact of duration of antimicrobial therapy for airway infections 20 …”

Section: Resultsmentioning

confidence: 99%

A systematic review of antimicrobial therapy in children with tracheostomies

Pearce,

Talks,

Powell

et al. 2023

Tracheostomies are indicated in children to facilitate long‐term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad‐spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centers. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from pediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy‐associated infections; this is largely based on the theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy‐associated infections remains largely unproven. This systematic review summarizes the current evidence base for antimicrobial selection, duration, and administration route in pediatric tracheostomy‐associated infections. It also highlights significant variation in practice between centers and the urgent need for further prospective evidence to guide the management of these vulnerable patients.