Airway Multidrug-Resistant Organisms in a Population of Tracheostomy and
Chronic Ventilator-Dependent Children at a Tertiary Care Pediatric
Hospital
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.