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Tracheostomized children tracheal colonization and antibiotic resistance profile - A STROBE analysis
G Vasconcellos Severo1, C Schweiger1, D Manica2
1Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350 - Santa Cecilia, 90035-007 Porto Alegre, Rio Grande do Sul, Brazil; Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), rua Ramiro Barcelos, 2400 sala 220, 90035-003 Porto Alegre, Rio Grande do Sul, Brazil.
Insights
Potentially pathogenic bacteria (PPB) are highly prevalent in children with tracheostomy, with Pseudomonas aeruginosa being the most common. Antimicrobial resistance in P. aeruginosa was linked to prior antibiotic use and hospital admissions.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Tracheostomy in children can lead to respiratory tract infections.
- Potentially pathogenic bacteria (PPB) are frequently found in tracheal secretions of these patients.
- Understanding the prevalence and antimicrobial resistance patterns of PPB is crucial for effective treatment.
Purpose of the Study:
- To determine the prevalence of PPB in tracheal aspirates of children with tracheostomy.
- To analyze the antimicrobial resistance profiles of isolated PPB.
- To correlate bacterial findings with clinical data.
Main Methods:
- A cross-sectional study was conducted on pediatric patients (0-18 years) undergoing tracheostomy cannula change.
- Tracheal aspirates were collected during the procedure for microbiological analysis and antimicrobial susceptibility testing.
- Clinical data were retrospectively reviewed from electronic medical records.
Main Results:
- A high prevalence of PPB (97.7%) was observed in cultured tracheal aspirates.
- Pseudomonas aeruginosa was the most frequently isolated bacterium (56.9%).
- P. aeruginosa exhibited resistance to gentamycin (36%), amikacin (28%), and cefepime (12%). Resistance correlated with prior antibiotic exposure and hospital admissions.
Conclusions:
- The study confirms a near-universal prevalence of PPB in pediatric tracheostomy patients.
- P. aeruginosa is the dominant pathogen, with notable antimicrobial resistance.
- Previous antibiotic use is associated with increased P. aeruginosa resistance, highlighting the need for judicious antibiotic stewardship.
Aims:
To verify the prevalence of Potentially pathogenic bacteria (PPB) and their antimicrobial resistance profile in tracheal aspirates of children with tracheostomy and compare it to clinical data.
Methods:
A cross-sectional study was conducted in patients aged 0-18 years who all underwent tracheostomy cannula change (TCC) performed by the Otolaryngology Unit at Hospital de Clínicas de Porto Alegre, Brazil, between October, 2017 and December, 2018. Patients were submitted, at the time of TCC, to a tracheal aspirate through the tracheostomy and secretion was sent to microbiological analysis and antimicrobial susceptibility testing. Clinical data were evaluated through available patients' electronic medical records.
Results:
Forty-four patients had their tracheostomy aspirate cultured and all but one presented PPB growth (97.7%). Median age was 3 years-old. Pseudomonas aeruginosa was the most prevalent bacteria (56.9%) and it was resistant to gentamycin, amikacin and cefepime in 36%, 28% and 12% of the culture tests, respectively. P. aeruginosa resistance to gentamycin and to cefepime suggested an association with the number of antibiotic classes used in the 12 months before enrollment (both p=0.04) and with 2 or more hospital admissions in the same period (p=0.03 and p=0.02, respectively). Staphylococcus aureus was isolated in 9.1% and there was no MRSA.
Conclusion:
It was found a 97.7% prevalence of PPB in the cultured aspirates; the most prevalent bacterium was P. aeruginosa and there was no MRSA identification. Data suggest an association between P. aeruginosa antimicrobial resistance with previous use of antibiotic therapy.
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