Abstract
Tracheostomies are indicated in children to facilitate long-term
ventilatory support, aid in the management of secretions, or to manage
upper airway obstruction. Children with tracheostomies often experience
ongoing airway complications, of which respiratory tract infections are
common. They subsequently receive frequent courses of broad spectrum
antimicrobials for the prevention or treatment of respiratory tract
infections. However, there is little consensus in practice with regard
to the indication for treatment/ prophylactic antimicrobial use, choice
of antimicrobial, route of administration, or duration of treatment
between different centres. Routine antibiotic use is associated with
adverse effects and an increased risk of antimicrobial resistance.
Tracheal cultures are commonly obtained from paediatric tracheostomy
patients, with the aim of helping guide antimicrobial therapy choice.
However, a positive culture alone is not diagnostic of infection and the
role of routine surveillance cultures remains contentious. Inhaled
antimicrobial use is also widespread in the management of tracheostomy
associated infections; this is largely based upon theoretical benefits
of higher airway antibiotic concentrations. The role of prophylactic
inhaled antimicrobial use for tracheostomy associated infections remains
largely unproven. This systematic review summarises the current evidence
base for antimicrobial selection, duration, and administration route in
paediatric tracheostomy associated infections. It also highlights
significant variation in practice between centres and the urgent need
for further prospective evidence to guide the management of these
vulnerable patients.