TY - JOUR
T1 - Airway multidrug-resistant organisms in a population of tracheostomy and chronic ventilator-dependent children at a tertiary care pediatric hospital
AU - Havens, Tara N.
AU - Rosen, David A.
AU - Rivera-Spoljaric, Katherine
N1 - Funding Information:
We thank Hongjie Gu who helped perform the statistical analysis and Michael Wallendorf, PhD who served as an advisor for statistical analysis through Division of Biostatistics at Washington University School of Medicine. No funding was provided for this study. All studies were conducted at the Department of Pediatrics, Division of Pediatric Allergy and Pulmonary Medicine, Washington University St. Louis, MO, USA.
Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2023/1
Y1 - 2023/1
N2 - Objective/Background: Children with tracheostomies are at an increased risk of bacterial respiratory tract infections. Infections caused by multidrug-resistant organisms (MDROs) are more difficult to treat and can result in severe complications. This study aimed to investigate the risk factors and sequelae of MDRO positivity in tracheostomy and chronic ventilator-dependent children. Methods: We performed a retrospective chart review of 75 tracheostomy and chronic ventilator-dependent children at St. Louis Children's Hospital. Data on demographics, respiratory cultures, hospitalizations, emergency department (ED) visits, and antibiotic usage were collected. We determined the frequency of MDRO positivity and compared the number of hospitalizations, number of ED visits, and antibiotic usage in patients with and without MDRO-positive cultures. Patient clinical variables were analyzed before and after MDRO acquisition. Results: We found 75.7% (56/74) of our participants had an MDRO-positive culture, with methicillin-resistant Staphylococcus aureus (MRSA, n = 36, 64%) and Pseudomonas aeruginosa (n = 8, 14%) being the most commonly detected organisms. Participants with a greater number of annual nonpulmonary admissions (odds ratio [OR] = 1.99, 95% confidence interval [CI] (1.21–3.29), p = 0.008], inpatient antibiotic courses [OR = 1.27, 95% CI (1.07–1.50), p = 0.006], total antibiotic courses [OR = 1.26, 95% CI (1.08–1.48), p = 0.004], and chronic antibiotic use [OR = 2.31, 95% CI (1.12–4.74), p = 0.03] were at an increased risk for MDRO positivity. Those who were MDRO-positive had more pulmonary admissions following MDRO acquisition compared those who were MDRO-negative [p = 0.005] but not more antibiotic usage or ED visits. Conclusion: Frequent antibiotic usage and hospitalizations increase the risk of MDRO acquisition in children with tracheostomies and ventilator-dependence. Further antibiotic stewardship may help prevent resistant infections in technology-dependent children.
AB - Objective/Background: Children with tracheostomies are at an increased risk of bacterial respiratory tract infections. Infections caused by multidrug-resistant organisms (MDROs) are more difficult to treat and can result in severe complications. This study aimed to investigate the risk factors and sequelae of MDRO positivity in tracheostomy and chronic ventilator-dependent children. Methods: We performed a retrospective chart review of 75 tracheostomy and chronic ventilator-dependent children at St. Louis Children's Hospital. Data on demographics, respiratory cultures, hospitalizations, emergency department (ED) visits, and antibiotic usage were collected. We determined the frequency of MDRO positivity and compared the number of hospitalizations, number of ED visits, and antibiotic usage in patients with and without MDRO-positive cultures. Patient clinical variables were analyzed before and after MDRO acquisition. Results: We found 75.7% (56/74) of our participants had an MDRO-positive culture, with methicillin-resistant Staphylococcus aureus (MRSA, n = 36, 64%) and Pseudomonas aeruginosa (n = 8, 14%) being the most commonly detected organisms. Participants with a greater number of annual nonpulmonary admissions (odds ratio [OR] = 1.99, 95% confidence interval [CI] (1.21–3.29), p = 0.008], inpatient antibiotic courses [OR = 1.27, 95% CI (1.07–1.50), p = 0.006], total antibiotic courses [OR = 1.26, 95% CI (1.08–1.48), p = 0.004], and chronic antibiotic use [OR = 2.31, 95% CI (1.12–4.74), p = 0.03] were at an increased risk for MDRO positivity. Those who were MDRO-positive had more pulmonary admissions following MDRO acquisition compared those who were MDRO-negative [p = 0.005] but not more antibiotic usage or ED visits. Conclusion: Frequent antibiotic usage and hospitalizations increase the risk of MDRO acquisition in children with tracheostomies and ventilator-dependence. Further antibiotic stewardship may help prevent resistant infections in technology-dependent children.
KW - antibiotics
KW - chronic respiratory failure
KW - emergency department visits
KW - hospitalizations
KW - multidrug-resistant organism
KW - pediatric tracheostomy
UR - http://www.scopus.com/inward/record.url?scp=85138578522&partnerID=8YFLogxK
U2 - 10.1002/ppul.26152
DO - 10.1002/ppul.26152
M3 - Article
C2 - 36100968
AN - SCOPUS:85138578522
SN - 8755-6863
VL - 58
SP - 26
EP - 34
JO - Pediatric Pulmonology
JF - Pediatric Pulmonology
IS - 1
ER -