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Pneumonia in Children With Complex Chronic Conditions With Tracheostomy: An Emerging Challenge
Miguel García-Boyano1, Francisco José Climent Alcalá2, Aroa Rodríguez Alonso2
1From the Pediatric Infectious and Tropical Diseases Department.
Insights
Pneumonia in children with tracheostomy tubes is common, with Pseudomonas aeruginosa being a frequent cause. Empirical antibiotic treatment should cover common bacteria and consider prior tracheal cultures for effective management.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Critical Care Medicine
Background:
- Respiratory infections are a major cause of hospitalization in children with tracheostomy tubes.
- No established guidelines exist for diagnosing and managing pneumonia in this vulnerable population.
- This study addresses the clinical, laboratory, and microbiological aspects of pneumonia in tracheostomized children.
Purpose of the Study:
- To outline the clinical, laboratory, and microbiological features of pneumonia in tracheostomized children.
- To identify commonly used antibiotics and their outcomes.
- To determine pneumonia incidence and associated risk factors in this cohort.
Main Methods:
- Retrospective study design.
- Utilized medical records of tracheostomized children from 2010-2021.
- Data collected on clinical presentation, microbiology, treatment, and outcomes.
Main Results:
- Thirty-three pneumonia cases were identified in 25 children.
- Pseudomonas aeruginosa was the most common pathogen (52%), followed by E. coli, S. aureus, and S. marcescens.
- Respiratory viruses were detected in 73% of cases via multiplex PCR; bacterial pathogens were frequently identified in prior tracheal cultures.
Conclusions:
- Empirical antibiotic therapy for pneumonia in tracheostomized children should cover P. aeruginosa, E. coli, S. aureus, and S. marcescens.
- Consideration of microorganisms from tracheal cultures within 7-30 days prior to pneumonia diagnosis is recommended.
- Viral respiratory infections often co-occur with bacterial pneumonia in this patient group.
Background:
Despite respiratory infections being a leading cause of hospitalization in children with tracheostomy tubes, there are no published guidelines for their diagnosis and management. This study aims to outline the clinical, laboratory and microbiological aspects of pneumonia in these children, along with the antibiotics used and outcomes. Additionally, it seeks to determine pneumonia incidence and associated risk factors.
Methods:
We conducted a retrospective study using the medical records of tracheostomized children at La Paz University Hospital in Madrid from 2010 to 2021.
Results:
Thirty-three pneumonia cases were observed in 25 tracheostomized children. Pseudomonas aeruginosa was the predominant bacterium (52%), followed by Escherichia coli , Staphylococcus aureus and Serratia marcescens . The same microorganism isolated in the tracheal aspirate culture during pneumonia was previously isolated in 83% of cases that had a similar culture, with some growth obtained within 7-30 days prior. Multiplex respiratory PCR detected respiratory viruses in 73% of cases tested. Antibiotic treatment was administered in all cases except 1, mostly intravenously (81%), with piperacillin/tazobactam and meropenem being commonly used. Only 1 of the described episodes had a fatal outcome.
Conclusions:
It is advisable to include coverage for P. aeruginosa , E. coli , S. aureus , and S. marcescens in the empirical antibiotic treatment for pneumonia in tracheostomized children, along with the microorganisms identified in tracheal cultures obtained within 7-30 days prior, if available. A positive PCR for respiratory viruses is often discovered in bacterial pneumonia in tracheostomized children.
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