Chest
Respiratory Infection Complicating Long-term Tracheostomy: The Implication of Persistent Gram-negative Tracheobronchial Colonization
Section snippets
MATERIALS AND METHODS
All individuals with long-term tracheostomies hospitalized at a local rehabilitative facility were potentially eligible for this study; however, we eliminated anyone with acute pneumonia, as defined by a thorough history, physical examination, and chest roentgenogram. Subjects meeting these criteria were selected for study if they were to remain in the hospital for at least four weeks and were free of pneumonia during this time. For one month after completion of the study, patients remaining in
Frequency of EGNB
The frequency of EGNB isolation was determined in multiple cultures from two respiratory mucosal sites (Table 1). During the study, 49 paired sets of serial buccal and tracheal mucosa cultures were collected from 15 subjects. The EGNB were isolated in 37 (76 percent) of 49 tracheal cultures, 28 of which contained Pseudomonas species. These included P aeruginosa, P maltophila, and other Pseudomonas species isolates. At the buccal site, 18 (37 percent) of 49 cultures contained EGNB, of which nine
DISCUSSION
Classic studies of hospitalized individuals have established that EGNB are present in the respiratory tract with a frequency that parallels certain aspects of serious illness. Thus, Johanson et al,6 using a multiple-culture survey technique, observed that these organisms were present in the oropharynx of only 6 percent of normal subjects, while they could be found in as many as 35 percent of moderately ill and 73 percent of moribund patients. More recently, Irwin et al13 confirmed the high rate
ACKNOWLEDGMENT
We thank Mrs. Mae Day and Ms. Joan Paquette for providing secretarial assistance and Dr. Curtland C. Brown and the medical administration of Gaylord Hospital for providing support for this study.
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Manuscript received May 9; revision accepted June 6.
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Recipient of an American Lung Association Fellowship and National Research Service Award training grant HL-07410-03.
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Supported by National Institutes of Health grant HL-22302.