Pseudomonas aeruginosa and post-tracheotomy bacterial respiratory tract infection readmissions

Abstract

Objective Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy. Design/Methods We performed a retrospective cohort study of 240 children who underwent tracheotomy and were discharged with tracheotsomy in place between 1/1/2005 and 6/30/2013. Children with prolonged total or post-tracheotomy length of stay (LOS), less than 12 months of follow-up, or who died during the index hospitalization were excluded. Readmission for a bTARTI (e.g., pneumonia, tracheitis) treated with antibiotics, as ascertained by manual chart review, was the outcome variable. We used multivariate logistic regression to identify the independent association between risk factors and hospital readmission for bTARTI within 12 months. Results At index hospitalizations for tracheotomy, the median admission age was 5 months [interquartile range (IQR) 2–43 months] and median LOS was 73 days (IQR 43–121 days). Most patients were of Hispanic ethnicity (n=162, 68%) and were publicly insured (n=213, 89%). Nearly half (n=112, 47%) were discharged on positive pressure mechanical ventilation. Many (n=103, 43%) were admitted for bTARTI within 12 months of discharge. Only Hispanic ethnicity [adjusted odds ratio (AOR) 2.0; 95% confidence interval (CI): 1.1–3.9; p=0.03)] and acquisition of Pseudomonas aeruginosa between tracheotomy and discharge from index hospitalization (AOR 3.2; 95% CI: 1.2–8.3; p=0.02) were independently associated with increased odds of bTARTI readmission, while discharge on gastrointestinal pro-motility agents was associated with decreased risk (AOR=0.4; 95% CI: 0.2–0.8; p=0.01). Conclusions Hispanic ethnicity and post-tracheotomy acquisition of Pseudomonas aeruginosa during initial hospitalization are associated with bTARTI readmission.

Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy

“…Some factors were associated with decreased risk for readmission for a bRTI, including congenital heart surgery repair during the index hospitalization, trauma comorbidity, and chronic ventilator dependence. The observed median time for bRTI hospital readmission in the current study was longer than a previous, single‐center study of post‐tracheotomy bRTI readmission …”

“…Cox proportional hazard model of factors associated with hospitalizations for a bacterial respiratory tract infection after tracheotomy Increased risk of hospital readmission for a bRTI and poorer outcomes in children with younger age, Hispanic ethnicity and government payer status complements findings of previous studies8,12,14,15,[22][23][24] and highlight potential opportunities to optimize…”

“…Because tracheostomy complications impact patient and family mental and physical health,identifying bRTI risk factors may inform bRTI prevention strategies to decrease antibiotic exposure, bacterial antibiotic resistance, and hospital readmission. One recent single‐center study of 240 pediatric patients showed that a few factors, including Hispanic ethnicity and Pseudomonas aeruginosa acquisition, were associated with increased odds of bRTI readmission post‐trachetomy . However, previous study findings were limited by small sample sizes to explore many risk factors.…”

Length of Stay and Hospital Revisit After Bacterial Tracheostomy–Associated Respiratory Tract Infection Hospitalizations

“…The authors of recent work have demonstrated that P aeruginosa is a common respiratory isolate in pediatric patients admitted with aspiration pneumonia 25,26 and in pediatric patients after tracheotomy. 27,28 This result complements recent work revealing an association between P aeruginosa isolation and poorer outcomes, including readmission for a bTARTI, 28 ICU admission, and intubation. 26 Receiving antibiotics targeting P aeruginosa may be a proxy for higher illness severity or increased likelihood of having multidrug-resistant organisms.…”

Antibiotics for Aspiration Pneumonia in Neurologically Impaired Children

“…Recent studies examining populations of children with cerebral palsy and/or tracheostomy have emphasized the high rates of carriage and infection rates with Gram-negative and drug-resistant bacteria; in particular, P. aeruginosa accounts for 50%-72% of pathogenic bacteria. 11,12,38,40 These studies note the generally poor outcomes of children with P. aeruginosa-including multiple and longer hospitalizations, frequent readmissions, and the increased severity of pneumonia, including the need for ICU admission, pleural effusions, the need for intubation, and mortality. 11,12,38,40,41 In our study, nearly 35% of children who received anaerobic, Gram-negative, and P. aeruginosa coverage experienced acute respiratory failure during hospitalization compared with 20% of children who received other therapies.…”