Chest
Original ResearchCritical CareSurveillance Tracheal Aspirate Cultures Do Not Reliably Predict Bacteria Cultured at the Time of an Acute Respiratory Infection in Children With Tracheostomy Tubes
Section snippets
Survey
In order to assess clinical practice patterns regarding the use of surveillance tracheal cultures, we conducted an Internet-based survey that was distributed via e-mail to pediatric pulmonologists on the ped-lung LISTSERV ([email protected]) and also to members of the American Society of Pediatric Otolaryngology. The survey asked the participants two questions: Do you obtain routine surveillance tracheal aspirate cultures from children with tracheostomies? If yes, do you use the routine
Survey
The survey yielded responses from 39 pediatric otolaryngologists and 150 pediatric pulmonologists. The results showed that 54% of pulmonologists and 15% of otolaryngologists obtained routine surveillance tracheal aspirate cultures in children with tracheostomy tubes (P < .001). Among those who obtained surveillance cultures, 80% of otolaryngologists and 97% of pulmonologists used these cultures to guide treatment of acute chest infections when they occurred.
Chart Analysis
A total of 170 children with
Discussion
This study provides further confirmation of airway colonization with potentially pathogenic bacteria in children who have long-standing tracheostomy tubes.7 Similar airway colonization occurs in respiratory diseases such as COPD and CF. The role of colonizing bacteria in the development of respiratory infections differs between these two diseases, resulting in different management strategies for individuals with CF or COPD. There has been no consensus on which strategy is most appropriate for
Conclusions
This study demonstrates large drift over time in bacterial flora of the tracheobronchial tree in children with tracheostomy tubes. The variability is evident when comparing outpatient tracheal aspirate cultures with inpatient cultures, as well as when comparing cultures from two separate hospital admissions. Additionally, change was noted in antibiotic sensitivity to persistent organisms among all comparisons. These findings suggest that there is limited value in using previous tracheal
Acknowledgments
Author contributions: Dr Kirse had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Cline: contributed to review and extraction of data from all patient charts, development of the data table, data analysis, and writing of the initial and final drafts of the manuscript.
Dr Woods: contributed to review of all data, statistical analysis, interpretation of the results and the meaning of the bacterial cultures,
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Cited by (37)
Republication of: Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis
2023, Annales Francaises d'Oto-Rhino-Laryngologie et de Pathologie Cervico-FacialeTracheostomized children tracheal colonization and antibiotic resistance profile – A STROBE analysis
2023, European Annals of Otorhinolaryngology, Head and Neck DiseasesCitation Excerpt :Although El cheik et al. study (2018) and ours were both performed in Brazil, a continental proportion country, the first was performed in a tropical zone and the second in a subtropical zone. Despite this fact, results from Brazilian studies were more similar between them to those performed in other countries such as Italy, Canada and the US, as previously discussed in section 4.3[6,17,24–26]. It may suggest that other factors, such as socioeconomic and demographic factors, are more important in determining colonization and infection than the climate zone; however, more studies are needed to confirm that hypothesis.
High microbiome variability in pediatric tracheostomy cannulas in patients with similar clinical characteristics
2023, Brazilian Journal of OtorhinolaryngologyCitation Excerpt :Precise determination of bacteria present at the tracheostomy tube can be challenging. Culture based methods may favor specific bacteria growth over others and does not contemplate the multitude of microbials present in that environment.7,13–15 Recently, high performance next generation sequencing equipment is becoming more accessible and, added to computational evolution and expansion of bioinformatic sector, genetic sequencing costs have been lower.16
Complications of tracheostomy in children: a systematic review
2022, Brazilian Journal of OtorhinolaryngologySeverity of sialorrhea and tracheal secretions in infants and toddlers with a tracheostomy with a focus on quality of life
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryRole of chlorhexidine on tracheostomy cannula decontamination in relation to the growth of Biofilm-Forming Bacteria Colony- a randomized controlled trial study
2021, Annals of Medicine and SurgeryCitation Excerpt :In the study group, 6 out of 7 Pseudomonas aeruginosa bacteria were eradicated by washing using chlorhexidine and 0.9% NaCl. This finding is inconsistent with previous studies, which stated that P aeruginosa biofilms exposed to chlorhexidine only decreased biofilm viability by 40%, and the P. aeruginosa bacterial strains on biofilms were resistant to antiseptics, where chlorhexidine with a minimum inhibitory concentration (MIC) could not destroy the biofilm. [10,26] The use of chlorhexidine as an antimicrobial also does not damage the cannula.
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).