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The effect of nebulized antibiotics in children with tracheostomy
Emine Atag1, Fusun Unal2, Huseyin Arslan1
1Medipol University Faculty of Medicine, Division of Pediatric Pulmonology, Istanbul, Turkey.
Insights
Nebulized antibiotics significantly reduced hospitalizations, intensive care unit stays, and bacterial load in children with tracheostomy and persistent colonization. This treatment offers a promising, safe approach to managing airway infections in this vulnerable population.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Respiratory Care
Background:
- Children with tracheostomy face heightened risks of bacterial colonization and lower respiratory tract infections.
- Persistent colonization in tracheostomized children can lead to recurrent infections and increased healthcare utilization.
Purpose of the Study:
- To evaluate the efficacy of nebulized antibiotics in reducing bacterial load.
- To assess the impact of nebulized antibiotics on hospitalizations and intensive care unit (ICU) length of stay.
- To determine the safety profile of nebulized antibiotic therapy in this patient group.
Main Methods:
- A cohort of tracheostomized children with persistent bacterial colonization post-respiratory infection was studied.
- Nebulized gentamicin or colistin was administered based on tracheal aspirate culture results.
- Clinical data were collected for one year before and one year after initiating nebulized antibiotic treatment.
Main Results:
- Nebulized antibiotic treatment (gentamicin or colistin) was given to 22 patients for a median of 3 months.
- Significant reductions were observed in hospitalizations (median 2 to 1) and ICU length of stay (median 89.5 to 25 days).
- Bacterial colony counts decreased significantly (median 10^5 to 6x10^4 CFU/ml) with no reported side effects.
Conclusions:
- Nebulized antibiotics effectively decrease bacterial load, hospitalizations, and ICU stays in tracheostomized children with persistent colonization.
- This therapeutic approach appears safe and may reduce the healthcare burden on patients, families, and the healthcare system.
- Further research is warranted to establish optimal indications and treatment durations for long-term nebulized antibiotic use.
Introduction:
Children with tracheostomy have an increased risk of bacterial colonization and infection of the lower respiratory tracts. This study aimed to investigate the effects of nebulized antibiotics on the bacterial load, the need for oral antibiotics, the number of hospitalizations, and the length of stay in the intensive care unit in tracheotomised children with persistent colonization.
Methods:
Children with tracheostomy and persistent bacterial colonization who were started on nebulized antibiotic therapy after a lower respiratory tract infection were included in the study. Nebulized gentamicin or colistin were used according to the results of the tracheal aspirate cultures. Demographic and clinic characteristics were recorded from one year prior until one year after initiation of nebulized antibiotic treatment.
Results:
Nebulized antibiotic treatment was initiated in 22 patients. Nebulized gentamicin was administered to 14 patients (63.6%) and colistin to 8 patients (36.4%). The median duration of treatment was 3 months (range 2-5 months). Following nebulized antibiotic treatment, median number of hospitalizations decreased from 2 (range 1.0-3.5) to 1 (range 0.0-1.5) (p = 0.04). The median length of stay in the intensive care unit reduced significantly from 89.5 days (range 43.0-82.5) to 25 days (range 7.75-62.75) after starting nebulized antibiotics (p = 0.028). Following nebulized antibiotic treatment median bacterial colony count also decreased (from 105 CFU/ml (range 105-106) to 6 × 104 CFU/ml (range 104-105); p = 0.003). There were no significant side effects during nebulized antibiotic therapy.
Conclusions:
The use of nebulized antibiotics reduced the number of hospitalizations, length of stay in the intensive care unit, and bacterial load in tracheotomised children with persistent airway colonization without significant side effects. The use of nebulized antibiotics showed a statistically significant decrease in the measures studied. Use of nebulized antibiotics may help to decrease the health care burden of these children, families and health care system. Further studies are needed to determine the indications and optimal duration of long-term nebulized antibiotic treatment in children with tracheostomy.
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