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Can early bacterial complications of aspiration with respiratory failure be predicted?
G A Kennedy1, R K Kanter, L B Weiner
1Department of Pediatrics, SUNY Health Science Center, Syracuse.
Insights
Early infections are common in children with respiratory failure after aspiration. Aggressive surveillance and early IV antibiotics are recommended due to unpredictable clinical signs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Aspiration of gastric or pharyngeal secretions poses a high risk for severe complications in pediatric intensive care.
- Early infectious complications can be life-threatening in critically ill children requiring mechanical ventilation.
Purpose of the Study:
- To investigate the incidence and characteristics of early infectious complications in high-risk pediatric patients.
- To evaluate the predictability of clinical signs for early-onset infections in this population.
Main Methods:
- Retrospective analysis of children admitted to intensive care with high-risk aspiration.
- Inclusion criteria: mechanical ventilation for acute respiratory failure, blood culture within 48 hours, survival >24 hours.
- Infections defined by positive blood cultures; possible infections by clinical signs and tracheal secretions.
Main Results:
- Five of 21 (23.8%) high-risk patients developed early infections within 48 hours.
- Two patients (9.5%) had possible early infections; no late infections were observed.
- Older age was associated with infection (P<0.05), but no early clinical signs reliably predicted infection (P>0.05).
Conclusions:
- Early-onset, life-threatening infections are frequent in pediatric patients with respiratory failure post-aspiration.
- Clinical signs within the first two days do not reliably predict these infections.
- Recommend aggressive bacteriologic surveillance and prompt IV antibiotic administration upon admission for at-risk patients.
Abstract:
We studied the early infectious complications of all children admitted for intensive care over a six-year period who were at high risk of having severe aspiration of gastric or pharyngeal secretions. Patients were only analyzed if they required mechanical ventilation for acute respiratory failure, had a blood culture obtained in the first 48 hours, and survived at least 24 hours. Infections were identified by positive blood cultures. Possible infections were defined as fever (over 38.5 degrees C), abnormal leukocyte count (greater than 10,000 or less than 5000), and a potential pathogen in tracheal secretions. Patients' diagnoses included near-drowning (13), aspirated foreign body (5), observed aspiration of gastric contents in a hospitalized patient (2), and hydrocarbon aspiration (1). Of 21 high-risk patients, five (23.8%) had infections and two (9.5%) had possible infections in the first 48 hours. In contrast, no late infections were seen. Infected patients tended to be older (P less than 0.05). No diagnostic features in the first two days of hospitalization reliably identified those who would develop early infections (P greater than 0.05). Since early life-threatening infection is common and cannot be reliably predicted by clinical signs, we recommend aggressive bacteriologic surveillance and the administration of IV antibiotics on admission to all patients in respiratory failure requiring mechanical ventilation after presumed aspiration of gastric or pharyngeal secretions.