Pneumococcal colonization among tracheostomy tube dependent children

Erdem, Güliz; Singh, Anirudh; Brusnahan, Anthony; Moore, Amber N.; Barson, William J.; Leber, Amy; Vidal, Jorge E.; Atıcı, Serkan; King, Samantha J.

doi:10.1371/journal.pone.0206305

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…18,19 A child with tracheostomy is almost considered at major infective risk compared to children without this device, so we expected an increased rate of infection in these children. Moreover, these children are frequently host of multidrug resistant pathogens due to frequent antibiotic treatments for respiratory tract infections [20][21][22][23][24][25][26][27] ; on the contrary, CLABSI rate in children with tracheostomy is lower than in those with PEG/PEJ and the simultaneous presence of both devices seems to have an "intermediate" risk. We speculate that the lower risk could account of "an increased attention" in the management of children with a highly invasive device especially in terms of "clean maneuvers."…”

Section: Discussionmentioning

confidence: 99%

The burden of central line-associated bloodstream infections in children with medical complexity

et al. 2021

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Background: Central line-associated bloodstream infections (CLABSI) are significant cause of complications in pediatric intensive care units (PICUs). An emerging challenge are CLABSIs in children with medical complexity (CMC) admitted to PICU. CMC are patients with chronic conditions with or without neurological impairment needing for tracheostomy and/or home mechanical or non-invasive ventilation and/or gastrostomy/jejunostomy. We evaluate CLABSI incidence in a PICU with high prevalence of CMC. Methods: This was a retrospective study in the PICU of the Bambino Gesù Children Hospital from January 2017 to December 2020. The medical records were reviewed and demographic, clinical and microbiological data were extracted. CLABSI were defined according to the Center for Disease Control and Prevention’s National Healthcare Safety Networks (NHSN) surveillance. Results: A total of 101 children with 125 central lines (CLs) were included; 79/101 (78%) patients were CMC and 50/101 (50%) had a thracheostomy. CLABSI incidence was 2.75/1000 CL-days (9 cases/3269 CL-days); incidence was 0 in patients without underling conditions and 3.14/1000 in CMC ( p < 0.001). CLABSI were due to gram negative bacteria in five patients, Candida spp in three and Staphylococcus hominis in one. CLs were removed in eight cases while in the later one, with CLABSI due to Pseudomonas aeruginosa, a conservative strategy was adopted cause of unavailable alternative venous access and removed at discharge with negative culture. All patients recovered. Conclusions: A target 0% CLABSI was possible in critically ill children without underling condition while a high incidence was reported in CMC and sustained by a peculiar CLABSI ecology. This ecology should be considered when a CLABSI was suspected in CMC for prompt antibiotics stewardship.

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Section: Discussionmentioning

confidence: 99%

The burden of central line-associated bloodstream infections in children with medical complexity

et al. 2021

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“…(Table 3). Twenty-eight studies (36%) discussed the microbiologic epidemiology of children with tracheostomy in several different capacities, including only children with tracheostomy (n = 14/28) 23,31,32,36,[50][51][52][53][54][55][56][57][58][59] or combining children with tracheostomy and those with endotracheal intubation (n = 7/ 28). 21,24,[60][61][62][63][64] Among studies focusing solely on children with tracheostomy, inhaled corticosteroid administration, 50 season/time of year, 55 mechanical ventilation dependence, 50,57 and pretracheotomy tracheal culture results 47,50,59 were associated with detection of specific bacteria including P. aeruginosa.…”

Section: Microbiology Of Trainsmentioning

confidence: 99%

Diagnosis, management, and outcomes of pediatric tracheostomy‐associated infections: A scoping review

Morrison

Hassan

Kysh

et al. 2022

Pediatric Pulmonology

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Background: Children with tracheostomy are frequently admitted to the hospital for tracheostomy-associated respiratory infections (TRAINs). However, there remains a paucity of evidence to direct the diagnosis, treatment, and prevention of TRAINs. An important first step to addressing this knowledge gap is to synthesize existing data regarding TRAINs to inform current practice and facilitate innovation. Data Sources: We searched PubMed, Embase, Cochrane Library, CINAHL, and Web of Science from inception to October 2020. Original research articles and published abstracts including children and young adults 0-21 years of age with tracheostomy were included. Included studies assessed the clinical definitions of and risk factors for TRAINs, microbiologic epidemiology and colonization of tracheostomies, and treatment and outcomes of TRAINs. Data Synthesis: Out of 5755 studies identified in the search, 78 full-text studies were included in the final review. A substantial number of studies focused on the detection of specific pathogens in respiratory cultures including Pseudomonas aeruginosa. Several different definitions of TRAIN including clinical, microbiologic, and laboratory testing results were utilized; however, no uniform set of criteria were identified. The few studies focused on treatment and prevention of TRAIN emphasized the role of empiric antimicrobial therapy and the use of inhaled antibiotics. Conclusions: Despite a growing number of research articles studying TRAINs, there is a paucity of prospective interventional trials to guide the diagnosis, treatment, and prevention of respiratory disease in this vulnerable population. Future research should include studies of interventions designed to improve short-and long-term respiratory-related outcomes of children with tracheostomy.

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Factors associated with tracheostomy‐associated infection treatment: A multicenter observational study

Morrison,

Kono,

Rush

et al. 2024

Pediatric Pulmonology

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ObjectiveTo characterize factors that influence the decision to treat suspected pediatric bacterial tracheostomy‐associated respiratory infections (bTRAINs; e.g., pneumonia, tracheitis).MethodsWe conducted a multicenter, prospective cohort study of children with pre‐existing tracheostomy hospitalized at six children's hospitals for a suspected bTRAIN (receipt of respiratory culture plus ≥1 doses of an antibiotic within 48 h). The primary predictor was respiratory culture growth categorized as Pseudomonas aeruginosa, P. aeruginosa + ≥1 other bacterium, other bacteria alone, or normal flora/no growth. Our primary outcome was bTRAIN treatment with a complete course of antibiotics as documented by the discharge team. We used logistic regression with generalized estimating equations to identify the association between our primary predictor and outcome and to identify demographic, clinical, and diagnostic testing factors associated with treatment.ResultsOf the 440 admissions among 289 patients meeting inclusion criteria, 307 (69.8%) had positive respiratory culture growth. Overall, 237 (53.9%) of admissions resulted in bTRAIN treatment. Relative to a negative culture, a culture positive for P. aeruginosa plus ≥1 other organism (adjusted odds ratio [aOR] 2.3; 95% confidence interval [CI] 1.02–5.0)] or ≥1 other organism alone (aOR: 2.8; 95% CI: 1.4–5.6)] was associated with treatment. Several clinical and diagnostic testing (respiratory Gram‐stain and chest radiograph) findings were also associated with treatment. Positive respiratory viral testing was associated with reduced odds of treatment (aOR: 0.5; 95% CI: 0.2–0.9).ConclusionsPositive respiratory cultures as well as clinical indicators of acute illness and nonculture test results were associated with bTRAIN treatment. Clinicians may be more comfortable withholding antibiotics when a virus is identified during testing.

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Pneumococcal colonization among tracheostomy tube dependent children

Cited by 3 publications

References 17 publications

The burden of central line-associated bloodstream infections in children with medical complexity

The burden of central line-associated bloodstream infections in children with medical complexity

Diagnosis, management, and outcomes of pediatric tracheostomy‐associated infections: A scoping review

Factors associated with tracheostomy‐associated infection treatment: A multicenter observational study

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