Lack of utility of tracheal aspirates in the management of suspected pneumonia in intubated neonates

Abstract

Objectives:To evaluate the utility of tracheal aspirates in suspected pneumonia in intubated neonates and to measure the burden of antibiotic use associated with a positive tracheal aspirate culture.Design:Retrospective cohort study between January 2016 and December 2017.Setting:A level IV neonatal intensive care unit (NICU).Patients:Intubated patients with a tracheal aspirate culture.Methods:Data on temporally associated clinical measures of illness, laboratory and radiographic testing, and clinical demographic information were analyzed.Results:Positive tracheal aspirate cultures were associated with lower birth weight and a normal immature to total neutrophil ratio (I/T ratio). Positive tracheal aspirates were not significantly associated with clinical, laboratory, or radiographic markers used in clinical practice to screen for infection. Despite the lack of positive clinical associations, a positive tracheal aspirate culture was associated with increased risk of prolonged antibiotic exposure.Conclusion:These findings suggest that positive tracheal aspirates do not always represent clinical infection and may result in unnecessary antibiotic exposure.

Association of Endotracheal Aspirate Culture Variability and Antibiotic Use in Mechanically Ventilated Pediatric Patients

“…16,19,[40][41][42] Multiple studies have shown no association between bacterial growth or inflammation with clinical findings of respiratory infection across pediatric and adult populations. 16,19,41,43 Various factors unrelated to the culture may affect the likelihood of infection such as inflammation, clinical status of the patient, and environmental exposures. 25,44 Recognizing that VAI may have substantial morbidity if untreated, reporting of bacteria in EAC results presents a challenge for the clinician and may antibiotic use regardless of the clinical relevance of the organism.…”

“…A complicating feature of EACs is that the respiratory secretions are sampling a nonsterile body site; therefore EACs may be limited in their ability to differentiate between bacteria colonizing the airway from those acting as pathogens . Multiple studies have shown no association between bacterial growth or inflammation with clinical findings of respiratory infection across pediatric and adult populations . Various factors unrelated to the culture may affect the likelihood of infection such as inflammation, clinical status of the patient, and environmental exposures .…”

Bacterial Respiratory Pathogens and Antimicrobial Resistance Profiles Isolated from Tracheal Aspirates in Intensive Care Units

“…SYE'li hastalardan trakeal salgıların elde edilmesi nispeten basit, minimal invaziv işlem gerektiren ucuz işlemlerdir. Buna rağmen, pozitif aspirat kültürlerinin entübe yenidoğanlarda klinik, laboratuvar veya radyografik bulgularıyla anlamlı bir ilişkisinin olmadığı; hastaların gereksiz ve uzun süreli antibiyotik etkisine maruz kalabileceği de belirtilmektedir (10) .…”