Introduction
Children require tracheostomies and long-term mechanical ventilation for
a variety of primary pulmonary and non-primary pulmonary diagnoses.
Tracheostomies bypass the respiratory tract’s normal protective barriers
and can serve as a conduit for bacterial colonization and subsequent
infection 1; 2. Tracheostomies are frequently
colonized with bacteria which may increase the risk of respiratory tract
infections including tracheitis and pneumonia3-5.
Respiratory tract infections in tracheostomy and ventilator-dependent
children are a frequent cause of hospitalization, morbidity, and health
care utilization6. Colonization and respiratory tract
infections from multidrug resistant organisms (MDROs) are a common
complication in this patient population. Lower respiratory tract
infections caused by MDROs can be more difficult to treat and have been
associated with worse clinical outcomes including increased number of
hospitalizations, increased length of hospital stay, prolonged intensive
care unit stays, and overall mortality 7-9.
There are no national guidelines available for treatment of respiratory
tract infections in chronic ventilator-dependent
children4; 6, and there is also paucity of medical
literature on this patient population. Most studies in tracheostomy and
ventilator-dependent children have been more descriptive in nature
focusing on occurrence rates of specific organisms and demographics.
Broad spectrum empiric antibiotics and chronic suppressive antibiotics
are frequently used in this population and could lead to increased
antibiotic resistance. Understanding which patient factors are
associated with respiratory MDROs could help guide clinical decision
making and antibiotic usage in this population.