Tracheostomy in children: Epidemiology and clinical outcomes

• Published in: Pediatric pulmonology Vol. 53; no. 9; pp. 1269 - 1275
• Main Authors: Sanders, Catherine D., Guimbellot, Jennifer S., Muhlebach, Marianne S., Lin, Feng‐Chang, Gilligan, Peter, Esther, Charles R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.09.2018
• Subjects: Adolescent; Child; Child, Preschool; children; chronic bacterial growth; Clinical outcomes; Cross Infection; Databases, Factual; Female; gram‐negative rods; Humans; Infant; Intensive care; Intensive Care Units; Intensive Care Units, Pediatric; Length of Stay; Male; North Carolina; Ostomy; Pathogens; Prosthesis-Related Infections; pseudomonas; Pseudomonas aeruginosa; Pseudomonas Infections - epidemiology; Pseudomonas Infections - surgery; Respiratory System; Retrospective Studies; Staphylococcal Infections - epidemiology; Staphylococcal Infections - surgery; Staphylococcus aureus; tracheostomy; Tracheostomy - adverse effects; Tracheostomy - methods; North Carolina; pseudomonas; chronic bacterial growth; children; tracheostomy; gram-negative rods
• ISSN: 8755-6863; 1099-0496; 1099-0496
• DOI: 10.1002/ppul.24071

Background Tracheotomy is performed in children for a variety of indications, but can place them at increased risk of lower airway infection with pathogenic organisms. While prior studies have identified Pseudomonas aeruginosa and Staphylococcus aureus as the most common lower airway pathogens in children with tracheostomies, little is known about the clinical implications of chronic growth of pathogens. Methods The North Carolina Children's Airway Center database was utilized to identify all pediatric patients with tracheostomy from 2007 to 2012; these data were cross‐referenced to a microbiology database of all tracheostomy cultures. Data on hospitalizations, intensive care unit admissions, and length‐of‐stay were ed from the medical record and analyzed using multivariate methods. Results We identified 185 children with tracheostomy, of whom chronic bacterial growth status could be defined in 69. P aeruginosa was a common pathogen isolated from tracheostomy cultures, with 49% (91/185) of patients growing this organism at least once. P aeruginosa combined with other gram‐negative rods were isolated in 63% (116/185) of subjects at least once. Those who chronically grew gram‐negative rods had significantly more hospitalizations, longer total lengths‐of‐stay, and longer intensive care unit lengths‐of‐stay than those who did not. These differences remained significant when data were normalized to account for number of available cultures. Conclusion These data suggest that clinical outcomes may be worse in children with tracheostomies who chronically grow gram‐negative rods. Our findings may help guide clinicians in managing children with tracheostomies, though further studies are needed to establish best practice guidelines in these patients.