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Airway Multidrug-Resistant Organisms in a Population of Tracheostomy and Chronic Ventilator-Dependent Children at a Tertiary Care Pediatric Hospital
  • Tara Havens,
  • David Rosen,
  • Katherine Rivera-Spoljaric
Tara Havens
Washington University in St Louis

Corresponding Author:[email protected]

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David Rosen
Washington University in St Louis
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Katherine Rivera-Spoljaric
Washington University in St Louis
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Abstract

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. We investigated 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. Patients with MDRO-positive cultures had a greater number of annual non-pulmonary admissions [OR=1.99, 95% 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] compared to MDRO-negative participants. Patients that acquired MDROs during the study period subsequently required increased outpatient antibiotics [P= 0.006] but did not have increased pulmonary admissions 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.
04 Feb 2022Submitted to Pediatric Pulmonology
07 Feb 2022Submission Checks Completed
07 Feb 2022Assigned to Editor
11 Feb 2022Reviewer(s) Assigned
10 Mar 2022Review(s) Completed, Editorial Evaluation Pending
15 Mar 2022Editorial Decision: Revise Major
04 May 20221st Revision Received
05 May 2022Submission Checks Completed
05 May 2022Assigned to Editor
05 May 2022Reviewer(s) Assigned
19 May 2022Review(s) Completed, Editorial Evaluation Pending
20 May 2022Editorial Decision: Revise Minor
22 Jun 20222nd Revision Received
17 Aug 2022Submission Checks Completed
17 Aug 2022Assigned to Editor
17 Aug 2022Reviewer(s) Assigned
01 Sep 2022Review(s) Completed, Editorial Evaluation Pending
02 Sep 2022Editorial Decision: Accept
Jan 2023Published in Pediatric Pulmonology volume 58 issue 1 on pages 26-34. 10.1002/ppul.26152