Abstract
Introduction Children with tracheostomy have an increased risk of
bacterial colonization and infections of the lower respiratory tracts.
This study aimed to investigate the effects of nebulized antibiotics on
the bacterial load, the need for oral antibiotic courses, the number of
hospitalizations, and the length of stay in the intensive care unit in
children with tracheostomy. Methods Children with tracheostomy and
persistent bacterial colonization who were started on nebulized
antibiotic therapy after a lower respiratory tract infection were
included to the study. Nebulized gentamicin or colistin were used
according to the results of tracheal aspirate cultures. Demographic and
clinic characteristics were recorded from one year before until 12
months after initiating nebulized antibiotic treatment. Results
Nebulized antibiotic treatment was initiated in 22 patients. Inhaled
gentamicin was administered to 14 patients (63.6%) and colistin to 8
patients (36.4%). The median duration of treatment was 3 months (2-5
months). Following nebulized antibiotic treatment, median number of
hospitalizations decreased from 2 (1-3.5) to 1 (0-1.5) (p=0.04). The
median length of stay in the intensive care unit reduced significantly
from 89.5 days (43-82.5) to 25 days (7.75-62.75) after starting
nebulized antibiotics (p = 0.028). Following nebulized antibiotic
treatment colony count also decreased (105 CFU/ml (105-106) vs. 6x104
CFU/ml (104-105); p=0.003). Conclusions Nebulize antibiotics are a
reasonable treatment option for lower respiratory tract infections for
tracheotomized children with persistent colonization. Further studies
are needed to determine the main indications and the optimal duration
and doses of the long-term nebulized antibiotic treatment in these
patients.