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.