Tracheostomy colonisation and microbiological isolates of patients in intensive care units‐a retrospective study

Abstract

ObjectiveTo find out the type of bacteria colonising the tracheostomy tube and to determine the antibiotic sensitivity pattern and resistance in patients who have had tracheostomy in intensive care unit (ICU) set up and to initiate proper empirical treatment in such patients.MethodsThe study was a retrospective review of patients who underwent tracheostomy at Ministry of Health, Sur Hospital, Oman January 2005 and December 2015. The Hospital has 4 bedded pediatric intensive care unit (PICU) and 10 bedded adult ICU which is headed by consultant anaesthetists, consultant physicians, ICU trained nurses and respiratory therapists. All patients who required mechanical ventilation and were therefore subject to an orotracheal intubation and those who underwent a conventional tracheostomy were considered for inclusion. Patients who had been intubated in other hospitals or ICUs, other airways infection issues were excluded from this study. Data's were collected from computer based hospital management system, operation theatre and registers in Medical records department and entered in a preformed questionnaire before thorough analysis. The specimens for swab was obtained from the cut tracheostomy tube tips and the samples were sent to microbiology laboratory for isolation of the organism and obtain an antibiogram to know the susceptibility and resistance to antibiotics. Data were analyzed by Statistical Package for Social Sciences (SPSS, version 16, Chicago, Inc) and the values are reported as number (%). The commonest isolated organism was Pseudomonas followed by Acinetobacter.ResultsDuring the ten year retrospective study, there were 108 patients included in our study with 56 males and 51 females. Fourteen different microorganisms were isolated during our study which included Pseudomonas aeruginosa (n = 39), Acinetobacter baumanii (n = 28), Klebsiella (n = 10) and coagulase negative staphylococcus (n = 6). The most commonest organisms in both genders was Pseudomonas aeruginosa closely followed by Acinetobacter baumanii. In children under age of 12, it was Pseudomonas aeruginosa and in adults the impending organism was Acinetobacter baumanii. In terms of antiobiograms, 89% of Acinetobacter, 38% of Staphylococcus aureus, 37% of Klebsiella and 54% of Proteus mirabilis were resistant to ciprofloxacin. These organisms were resistant to ceftazidime in 97%, 83%, 89% and 57% of the cases, respectively and resistant to imipenem in 7.4%, 18.2%, 1.8% and 8.1%.ConclusionsIn summary, this study presents the most common microorganisms colonized from tracheostomy of hospitalized patients and their pattern of antibiotic resistance. As our study showed, Pseudomonas is the most common microorganism isolated from tracheostomy tube. Ciprofloxacin was also the most prevalent antibiotic revealing resistant pattern. Moreover, most of the microorganisms were sensitive to imipenem and pipracillin‐tazobactam.

Biofilm Formation of Clinical Klebsiella pneumoniae Strains Isolated from Tracheostomy Tubes and Their Association with Antimicrobial Resistance, Virulence and Genetic Diversity

“…Similar results of large genetic diversity among hospital-sourced K. pneumoniae examined using the PFGE method were obtained by Alcántar-Curiel et al, who identified among 168 isolates 59 different PFGE profiles [ 14 ]. However, the above observations are difficult to discuss with other Polish and international authors due to the small number of studies covering genetic relatedness and concentrating solely on K. pneumoniae strains isolated from tracheal secretions from tracheostomy tubes rather than isolates derived from a variety of other clinical materials [ 1 , 5 , 14 , 36 ].…”

“…Tracheotomy is one of the oldest and most often conducted otolaryngological surgical procedures. It involves the creation of an opening in the front wall of the trachea so that a tracheostomy tube can be inserted into the lumen of the airways [ 1 , 2 , 3 ]. Healthcare-associated infections (HCAIs) developing in patients with tracheostomy are a significant problem for modern medicine and are much more common in this group of patients than in others.…”

“…It should be emphasized that patients with tracheostomies are colonized by a variety of bacterial microflora as a result of massive colonization of the tracheostomy tube. Along with insufficient care of the patient, this may lead to a relocation of the microorganisms in the lower parts of the respiratory tract and thence to the initiation of the inflammatory process [ 1 , 5 ]. The most common infections reported among patients with tracheostomies are respiratory tract infections manifesting as ventilator-associated pneumonia (VAP), which can be expected to develop in 4–28% of patients [ 1 , 4 , 6 , 7 ].…”

“…Other important complications following this procedure include wound infections around the stomata and the possibility of the development of chronic otitis media with effusion, which is commonly observed in Ear, Nose and Throat (ENT) units [ 1 , 2 , 8 , 9 ]. A clinically significant group of infections are those closely related to the biomaterials applied in modern medicine (biomaterial-associated infections—BAIs).…”

“…Bacterial biofilms are present in more than 90% of tracheostomy tubes collected in both inpatient and outpatient settings [ 12 ]. All indwelling tracheostomy tubes are contaminated with normal and sometimes pathogenic flora [ 1 , 8 ]. A wide spectrum of pathogenic microorganisms have the ability to adhere, colonize and, consequently, to form biofilms on the surface of tracheostomy tubes [ 14 , 15 ].…”