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Research ArticleOriginal Research

Airway Microbiology in Tracheostomized Children

Dythea McLaren, Marie Chitakis, Hannah Burns and Nitin Kapur
Respiratory Care February 2021, 66 (2) 281-285; DOI: https://doi.org/10.4187/respcare.07890
Dythea McLaren
School of Medicine, Griffith University, Brisbane, Queensland, Australia.
Redcliffe Hospital, Redcliffe, Queensland, Australia.
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  • For correspondence: [email protected]
Marie Chitakis
Department of Otolaryngology Head & Neck Surgery, Queensland Children’s Hospital, South Brisbane, Queensland, Australia.
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Hannah Burns
Department of Otolaryngology Head & Neck Surgery, Queensland Children’s Hospital, South Brisbane, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Nitin Kapur
Department of Respiratory & Sleep Medicine, Queensland Children’s Hospital, South Brisbane, Queensland, Australia.
School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
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Abstract

BACKGROUND: Potentially pathogenic microorganisms are frequently isolated from tracheostomized children, although evidence for empirical therapy of respiratory exacerbation is limited. We aimed to describe upper airway microbiology as found on endotracheal aspirate (ETA) in tracheostomized children and to correlate it with lower airway microbiology through bronchoalveolar lavage fluid.

METHODS: We retrospectively reviewed records and airway microbiology of all tracheostomized children under the follow-up care of Queensland Children’s Hospital. Subanalysis was based on ventilatory and multidrug-resistant organism status. Sensitivity and specificity of ETA for predicting Pseudomonas aeruginosa and Staphylococcus aureus lower airway isolation were calculated using concomitant bronchoalveolar lavage fluid culture as the accepted standard.

RESULTS: From 43 children (18 female, median [interquartile range (IQR)] age 68 (41–115) months, 14 ventilated), 15 different potentially pathogenic microorganisms were isolated (mean ± SD: 3.30 ± 2.23), with S. aureus (n = 33, 77%) and P. aeruginosa (n = 29, 67%) predominating. Significantly more types of potentially pathogenic microorganisms were isolated from ventilated children (median 4.00 [IQR 3.25–5.75]) than from nonventilated children (median 2.00 [IQR 1.00–4.00] (P = .007), with 93% of ventilated children isolating S. aureus and 86% P. aeruginosa. Multidrug-resistant organisms were present in 12 (28%) children, of whom 8 were ventilated. Methicillin-resistant S. aureus (MRSA) was isolated in 9 (21%) children, of whom 6 were ventilated. For P. aeruginosa and S. aureus isolation, ETA had high sensitivity (95% and 100%, respectively) but low specificity (64.7% and 33.3%, respectively) when compared with bronchoalveolar lavage fluid.

CONCLUSIONS: In children with tracheostomy, the predominant respiratory bacterial pathogens were S. aureus and P. aeruginosa, with MRSA being isolated less frequently than previously described. Multidrug-resistant organisms are isolated more frequently from ventilated children. ETA microbiology is a good screening modality, with negative ETA potentially ruling out lower airway S. aureus and P. aeruginosa. Adequately powered prospective studies with quantitative cultures could enhance understanding and guide therapy.

  • tracheostomy
  • bronchoalveolar lavage fluid
  • Pseudomonas aeruginosa
  • airway microbiology
  • respiratory system
  • child

Footnotes

  • Correspondence: Dythea McLaren MD. E-mail: dythea.mclaren{at}health.qld.gov.au
  • Dr Kapur presented a version of this paper at the ERS International Congress 2019, held September 28 to October 2, 2019, in Madrid, Spain. Dr McLaren presented a version of this paper at TSANZSRS 2019, held March 29 to April 2, 2019, in Gold Coast, Australia.

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (2)
Respiratory Care
Vol. 66, Issue 2
1 Feb 2021
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Airway Microbiology in Tracheostomized Children
Dythea McLaren, Marie Chitakis, Hannah Burns, Nitin Kapur
Respiratory Care Feb 2021, 66 (2) 281-285; DOI: 10.4187/respcare.07890

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Airway Microbiology in Tracheostomized Children
Dythea McLaren, Marie Chitakis, Hannah Burns, Nitin Kapur
Respiratory Care Feb 2021, 66 (2) 281-285; DOI: 10.4187/respcare.07890
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Keywords

  • tracheostomy
  • bronchoalveolar lavage fluid
  • Pseudomonas aeruginosa
  • airway microbiology
  • respiratory system
  • child

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