Respiratory tract infections in children with tracheostomy

Tan, Chiew Yin; Chiu, Nan Chang; Lee, Kuo Sheng; Chi, Hsin; Huang, Fu Yuan; Huang, Di; Chang, Lung; Kung, Yen Hsin; Huang, Ching Ying

doi:10.1016/j.jmii.2018.07.002

Cited by 32 publications

(44 citation statements)

References 19 publications

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“…Our findings support those of other recent studies investigating the respiratory microbiology of tracheostomized children, which suggest a predominance of P. aeruginosa at 90% and other Gram-negative organisms and S. aureus at 46%. 12,13 Notably, we had a much lower incidence of MRSA in our cohort at 21% than previously reported, where MRSA was a predominant organism with a reported incidence of 56%. Our findings were in keeping with nationally decreasing rates of MRSA in Australia, particularly hospital-acquired MRSA.…”

Section: Discussioncontrasting

confidence: 52%

“…[9][10][11] There are limited data available describing the lower respiratory microbiology in tracheostomized children, and consequently limited evidence to guide empirical therapy in the event of respiratory exacerbation in this cohort. 12,13 Studies comparing upper and lower airway pathogens in children with cystic fibrosis and those with intercurrent lower respiratory tract infections indicate that upper airway microbiology has high sensitivity and negative predictive values, but poor positive predictive values, for lower airway microbiology. [14][15][16][17] To our knowledge, there are limited data of this kind in tracheostomized children.…”

Section: Introductionmentioning

confidence: 99%

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Airway Microbiology in Tracheostomized Children

et al. 2020

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BACKGROUND: Potentially pathogenic microorganisms are frequently isolated from tracheostomized children, although evidence for empirical therapy of respiratory exacerbation is limited. We aimed to describe upper airway microbiology as found on endotracheal aspirate (ETA) in tracheostomized children and to correlate it with lower airway microbiology through bronchoalveolar lavage fluid. METHODS: We retrospectively reviewed records and airway microbiology of all tracheostomized children under the follow-up care of Queensland Children's Hospital. Subanalysis was based on ventilatory and multidrug-resistant organism status. Sensitivity and specificity of ETA for predicting Pseudomonas aeruginosa and Staphylococcus aureus lower airway isolation were calculated using concomitant bronchoalveolar lavage fluid culture as the accepted standard. RESULTS: From 43 children (18 female, median [interquartile range (IQR)] age 68 (41-115) months, 14 ventilated), 15 different potentially pathogenic microorganisms were isolated (mean 6 SD: 3.30 6 2.23), with S. aureus (n 5 33, 77%) and P. aeruginosa (n 5 29, 67%) predominating. Significantly more types of potentially pathogenic microorganisms were isolated from ventilated children (median 4.00 [IQR 3.25-5.75]) than from nonventilated children (median 2.00 [IQR 1.00-4.00] (P 5 .007), with 93% of ventilated children isolating S. aureus and 86% P. aeruginosa. Multidrug-resistant organisms were present in 12 (28%) children, of whom 8 were ventilated. Methicillin-resistant S. aureus (MRSA) was isolated in 9 (21%) children, of whom 6 were ventilated. For P. aeruginosa and S. aureus isolation, ETA had high sensitivity (95% and 100%, respectively) but low specificity (64.7% and 33.3%, respectively) when compared with bronchoalveolar lavage fluid. CONCLUSIONS: In children with tracheostomy, the predominant respiratory bacterial pathogens were S. aureus and P. aeruginosa, with MRSA being isolated less frequently than previously described. Multidrug-resistant organisms are isolated more frequently from ventilated children. ETA microbiology is a good screening modality, with negative ETA potentially ruling out lower airway S. aureus and P. aeruginosa. Adequately powered prospective studies with quantitative cultures could enhance understanding and guide therapy.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Airway Microbiology in Tracheostomized Children

et al. 2020

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“…Among infants and children, risk factors include prematurity, comorbidities such as chronic lung disease of prematurity (CLDP; formerly known as bronchopulmonary dysplasia [BPD]) or congenital heart disease (CHD), chromosomal abnormalities such as Down syndrome, immunodeficiency, and cystic fibrosis [ 12 , 27 ]. Children with congenital airway abnormalities (larynx, trachea, and bronchi), tracheostomy, and neuromuscular disease are also at higher risk of developing severe complications when infected with RSV [ 28 , 29 ]. Adults who are immunosuppressed, receiving an organ transplant, or aged ≥ 65 years are at increased risk of severe RSV disease [ 27 ].…”

Section: Populations At Increased Risk For Rsv Infectionmentioning

confidence: 99%

Current State of Respiratory Syncytial Virus Disease and Management

Chatterjee

Mavunda²,

Krilov

2021

Infect Dis Ther

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Respiratory syncytial virus (RSV) is a major cause of hospitalizations due to pneumonia and bronchiolitis. Substantial morbidity and socioeconomic burden are associated with RSV infection worldwide. Populations with higher susceptibility to developing severe RSV include premature infants, children with chronic lung disease of prematurity (CLDP) or congenital heart disease (CHD), elderly individuals aged > 65 years, and immunocompromised individuals. In the pediatric population, RSV can lead to long-term sequelae such as wheezing and asthma, which are associated with increased health care costs and reduced quality of life. Treatment for RSV is mainly supportive, and general preventive measures such as good hygiene and isolation are highly recommended. Although vaccine development for RSV has been a global priority, attempts to date have failed to yield a safe and effective product for clinical use. Currently, palivizumab is the only immunoprophylaxis (IP) available to prevent severe RSV in specific high-risk pediatric populations. Well-controlled, randomized clinical trials have established the efficacy of palivizumab in reducing RSV hospitalization (RSVH) in high-risk infants including moderate- to late-preterm infants. However, the American Academy of Pediatrics (AAP), in its 2014 policy, stopped recommending RSV IP use for ≥ 29 weeks’ gestational age infants. Revisions to the AAP policy for RSV IP have largely narrowed the proportion of pediatric patients eligible to receive RSV IP and have been associated with an increase in RSVH and morbidity. On the other hand, after reviewing the recent evidence on RSV burden, the National Perinatal Association, in its 2018 clinical practice guidelines, recommended RSV IP use for a wider pediatric population. As the AAP recommendations drive insurance reimbursements for RSV IP, they should be revised to help further mitigate RSV disease burden.

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“…The lower respiratory tract is cleared by the effect of coughing and the mucociliary clearance of the nasal mucosa leading to expelling of secretions and possible intruding agents; unfortunately, tracheostomy is associated with lack of these two protective mechanisms. On the other hand, the presence of a tube inside respiratory passages for a long period of time will lead to inflammation and formation of a nidus for infectious micro-organisms and biofilm formation [5][6][7] . In addition, the tube itself provides a surface for strong adherence of microorganism, thereby, avoiding the immune mechanism and antibiotic attack and making the rate of infection even higher in the setting of tracheostomy 6 .…”

Section: Introductionmentioning

confidence: 99%

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

Safaa Hussain Alturaihy

2020

Indian Journal of Forensic Medicine & Toxicology

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Background: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. 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. Little information is available about complications of tracheostomy in Hilla general teaching hospital.Aim of the study: to highlight the main indications and complications in association with tracheostomy in pediatric age group in Hilla, Babylon province, Iraq. Patients and methods:The current prospective study included 41 children less than 12 years of age form the pool of patients admitted to intensive care unit at Hilla General Teaching Hospital and the intensive care unit at Babel Pediatric and Maternity Teaching Hospital. The study extended from March 2018 to September 2019. All those children underwent tracheostomy for a variety of reasons. They were followed up for one year for recoding any possible complication in association with tracheostomy procedure.Results: After one year of follow up, the time until decannulation was ranging between 45 to 365 days with a mean of 61.73 days. Upper air way obstruction was seen in 12 cases while assisting ventilation in prolonged intubation was seen in the majority, 30 cases. Causes of upper airway obstruction were Craniofacial anomaly, Subglottic stenosis, Laryngotracheal stenosis, Vocal fold paralysis and Subglottic hemangioma. The reasons for prolonged intubation included Neuromuscular disease, Postoperative period following major surgery, Respiratory failure, Trauma and Subglottic hemangioma. Conclusion:The main indications for tracheostomy in children were congenital upper air way obstruction and the need for prolonged mechanical ventilation and the main complications are either intermediate cannula loss or late subglotic obstruction.

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Respiratory tract infections in children with tracheostomy

Abstract: In this study, CP and GERD were associated with infections in children with tracheostomy. Bacterial and non-bacterial pneumonia are difficult to differentiate clinically which may lead to unnecessary antibiotics use.

Cited by 32 publications

References 19 publications

Airway Microbiology in Tracheostomized Children

Airway Microbiology in Tracheostomized Children

Current State of Respiratory Syncytial Virus Disease and Management

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

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