Variation in Bacterial Respiratory Culture Results in Children With Neurologic Impairment

Abstract

OBJECTIVES To examine bacterial respiratory cultures in children with neurologic impairment (NI) (eg, cerebral palsy), both with and without tracheostomies, who were hospitalized with acute respiratory infections (ARIs) (eg, pneumonia) and to compare culture results across hospitals and age groups. METHODS This multicenter retrospective cohort study included ARI hospitalizations for children aged 1 to 18 years with NI between 2007 and 2012 who had a bacterial respiratory culture obtained within 2 days of admission. Data from 5 children’s hospitals in the Pediatric Health Information System Plus database were used. Organisms consistent with oral flora and nonspeciated organisms were omitted from analysis. The prevalence of positive respiratory culture results and the prevalence of organisms identified were compared across hospitals and age groups and in subanalyses of children with and without tracheostomies by using generalized estimating equations to account for within-patient clustering. RESULTS Of 4900 hospitalizations, 693 from 485 children had bacterial respiratory cultures obtained. Of these, 54.5% had positive results, although this varied across hospitals (range 18.6%–83.2%; P < .001). Pseudomonas aeruginosa and Staphylococcus aureus were the most commonly identified organisms across hospitals and age groups and in patients with and without tracheostomies. Large variation in growth prevalence was identified across hospitals but not age groups. CONCLUSIONS The bacteriology of ARI in hospitalized children with NI differs from that of otherwise healthy children. Significant variation in prevalence of positive bacterial respiratory culture results and organism growth were observed across hospitals, which may be secondary to local environmental factors and microbiology reporting practices.

Respiratory Culture Growth and 3-Year Lung Health Outcomes in Children with BPD and Tracheostomies

“…42 On the other hand, children who are at risk for chronic P. aeruginosa due to immunocompromised status, comorbidities, or high hospital utilization are also likely at higher risk for mortality related to these non-pseudomonal factors, as has been reported in other populations. 37,[43][44][45][46][47] This study demonstrated a similar overall mortality rate to that reported in other studies of infants and young children with severe BPD and tracheostomies. 9 In survival analysis, we identified that most deaths occurred in the first 1 year following tracheostomy placement.…”

“…Furthermore, our center's results may not be generalizable to other institutions; our institution's positive culture prevalence is notably lower than that observed at other institutions, 20,50 but consistent with our prior internal studies. 21,44 This lower prevalence is hypothesized to be related to differences in our population and/or local factors (e.g., infection control policies, lab reporting procedures). Similarly, as noted above, the number of children meeting chronic P. aeruginosa identification criteria was very small which limits the conclusions from that subgroup's analyses.…”

Respiratory Culture Organism Isolation and Test Characteristics in Children with Tracheostomies with and without Acute Respiratory Infection

“…However, studies have demonstrated wide inter-institutional variability in culture ordering practices, microbiology lab processing, culture results (both positivity rate and organism type), and clinician response to results. 5,7,39 Variability in sample quality and lab processing may also contribute, as has been documented in endotracheal tube cultures. 39 The consequence of this variability is clinical inconsistency in diagnosing ARI, 5 use of and types of antibiotic treatment, 32 and probably also patient outcomes including severity, length of illness, and respiratory support needs, all of which limit research and improvement efforts.…”

“…5,6 Although easy to order and obtain in children with tracheostomies, the interpretation of respiratory cultures is highly complex due to many confounding factors, which have largely been understudied. 7 A major contributor to the difficulty in interpreting culture results in this population is a lack of a robust epidemiologic understanding of organisms expected to be isolated during true ARI, let along during states of wellness. The respiratory tract, unlike other body compartments from which cultures are obtained (e.g., urine, blood), is not a sterile site and harbors oropharyngeal flora in children with and without tracheostomies.…”

Microbiota of preterm infant develops over time along with the first teeth eruption

“…There was a high abundance of Pseudomonas spp. at baseline that decreased afterward, which may be because of hospitalization and antibiotic use of premature infants ( Henares et al, 2021 ; Warniment et al, 2021 ). Common nosocomial genera, including Staphylococcus , Acinetobacter , and Pseudomonas, developed in infants subjected to antibiotics ( Henares et al, 2021 ).…”