Prevalence of Streptococcus pneumoniae in Respiratory Samples from Patients with Tracheostomy in a Long-Term-Care Facility

Abstract

We aimed to study the prevalence of Streptococcus pneumoniae in respiratory samples from institutionalized patients with chronic tracheostomy. A total of 264 pairs of nasopharyngeal and endotracheal cultures were collected. There was no difference in the proportion of positive cultures between children (21%) and adults (18%). However, the proportion of positive endotracheal cultures was higher than that of nasopharyngeal cultures in adults (18% versus 3%, respectively; P < 0.001) but not in children (17% in both sites). Infection with Streptococcus pneumoniae can result in a range of illnesses, including bacteremia, meningitis, pneumonia, otitis media, and sinusitis, which together cause substantial morbidity and mortality worldwide (7). S. pneumoniae gains entry into the host by colonizing the nasopharyngeal (NP) mucosal epithelium. Although colonization at this site is usually asymptomatic, if the organism gains access to the normally sterile parts of the airway a rapid inflammatory response ensues, resulting in disease (6, 7). The colonization rate is much higher in young children than in adults (8) and is influenced by a variety of factors, including geographic location, season, overcrowding, and day care attendance (6). There is a paucity of data regarding the presence of S. pneumoniae in the lower respiratory tract (LRT) of individuals without acute infection. The data suggest that S. pneumoniae is absent in the airways of healthy individuals (4) or in children with recurrent wheezing (9), but it can be detected in a small proportion (7%) of patients with chronic obstructive pulmonary disease (COPD) (4). An epidemiologically distinct subpopulation among patients with chronic respiratory disorders comprises those with chronic tracheostomy tubes. In these patients, bacterial LRT colonization almost always follows tracheal intubation (3). Two studies reported a prevalence of S. pneumoniae in LRT cultures in chronic tracheostomy patients of 8% (4) and 42% (3). However, these studies were conducted on a small number of patients and did not include a concurrent assessment of the nasopharyngeal carriage rate. The aims of the present study were to study the prevalence of S. pneumoniae in respiratory samples of patients with chronic tracheostomy, to compare the carriage rates found in NP versus endotracheal (ET) cultures, and to assess the effects of demographic and microbiologic variables on the site of isolation.The Reuth Medical Center in Tel Aviv is a 300-bed, long-termcare facility (250 adults, 50 children) with patients divided into the following wards: chronically ventilated (adult and pediatric), rehabilitation, and skilled nursing care. The study was conducted in the context of an intervention initiated by the National Center for Infection Control to investigate the prevalence of fluoroquinolone-resistant S. pneumoniae in clinical cultures at the facility (10). A point prevalence surveillance study of S. pneumoniae colonization was conducted first in January 2009 followed by two follow-up surveys in Decemb...

Prevalence of respiratory colonisations and related antibiotic resistances among paediatric tracheostomised patients of a long-term rehabilitation centre in Italy

“…Finally, it should be emphasised that only symptomatic patients were receiving antibiotics during rehabilitation (data not shown) and this may possibly lead to more bacterial colonisations. Interestingly, S. pneumoniae was detected only twice in our cohort, at variance with other studies that reported higher prevalence in long-term tracheostomised patients [30]. The relative prevalence we found among species was in fact very similar to the one described in a recent review on nosocomial pneumonia [2]; possible explanations of discrepancies in the reported prevalence of S. pneumoniae may comprise, but are not limited to, different geographical locations (involving different provenance hospitals and environments) and treatment habits, both before and during rehabilitation.…”

Pneumococcal colonization among tracheostomy tube dependent children

“…The study by Adler et al . 2012 identified the serotype of isolates; however, they did not differentiate the isolates from adult and pediatric patients [ 4 ]. The serotypes of the 45 isolates from the trachea or trachea and nasopharynx were 23F, 19F, 17F, 15A, 6A and non-typeable.…”

“…Levels of colonization are higher in children than adults and certain groups of patients could be at increased risk of developing pneumococcal infection [ 1 – 3 ]. Patients with tracheostomies have pneumococcal colonization of their lower respiratory tract; however, little is known about the strains colonizing these patients [ 4 , 5 ]. A study published in 1979 examined pneumococcal colonization of 27 children (mean age of 8.5 years) biweekly over a one year period [ 5 ].…”

“…Pneumococci were isolated from 22.5% of the 444 samples taken; although, 22 of those isolates were from patients with active pneumonia. A more recent study of tracheostomy patients, both adults and children, at a long-term care facility revealed 17% of cultures were positive for pneumococci [ 4 ]. This study also defined the serotypes of endotracheal isolates.…”

Tracheotomy/Tracheostomy Management at Home and in Care Centers

“…-Loss of natural protection by oral and nasal fence allowing direct contamination of microorganisms in the trachea and bronchi. There are very few correlations in microorganisms between the upper aerodigestive tract and the tracheobronchial tract [14][15][16].…”