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

Abstract

Ventilator-dependent patients <12 months old with at least 4 CCCs are at highest risk for both longer LOS and 30-day revisit after discharge for bTARTIs. They may benefit from bTARTI prevention strategies and intensive care coordination while hospitalized.

Tracheostomy trends in preterm infants with bronchopulmonary dysplasia in the United States: 2008–2017

“…On the surface, the implications of the increase in the frequency of tracheostomy placement in preterm infants with BPD will appear worrying given that a recent study by DeMauro et al 30 demonstrated that very preterm infants with tracheostomies had increased odds for death or neurodevelopmental impairment at a corrected age of 18–22 months. Furthermore, tracheostomy placement in infants is associated with increased risk of readmission 31 . This may compound the increased readmission risk particularly for respiratory tract infections in infants with BPD 2 .…”

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.…”

“…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. While these results might seem to suggest that broader spectrum therapy is harmful, they must be interpreted in the context of important population differences; children who received a combination of anaerobic, Gram-negative, and P. aeruginosa coverage had greater medical complexity and greater severity of illness on presentation.…”

Tracheostomy tube infection in children: a systematic review of the literature

“…According to the results (Table 3) of the selected articles, the comorbidities that were described as most frequently associated with infection of the tracheostomy tube in children were: neuromuscular disease [10][11][12][13][14][15] , prematurity 13,19,21 , congenital anomalies 11,13,16,18 , and others, less frequently, such as chronic lung disease 19,20 , obstruction airway 15,19 , cystic fibrosis 16 , heart disease 18 , and acquired ab- normalities 11,13 . There also existed an association of different comorbidities in the same patients.…”

“…The factors associated with length of stay (LOS) were the age from 30 days to 12 months, with a greater probability of re-entering the hospital, and the presence of 4 or more complex chronic diseases (adding a greater possibility of readmission). Concerning a longer LOS, the following were considered: the principal diagnosis of aspiration pneumonia and admission to the ICU at some point during hospitalization 15 .…”