Russell Christopher J, Simon Tamara D, Mamey Mary R, Newth Christopher J L, Neely Michael N
Divisions of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Department of Pediatrics, Keck School of Medicine, University of Southern California.
Pediatr Pulmonol. 2017 Sep;52(9):1212-1218. doi: 10.1002/ppul.23716. Epub 2017 Apr 25.
Identify risk factors for readmission due to a bacterial tracheostomy-associated respiratory tract infection (bTARTI) within 12 months of discharge after tracheotomy.
DESIGN/METHODS: We performed a retrospective cohort study of 240 children who underwent tracheotomy and were discharged with tracheotsomy in place between January 1, 2005 and June 30, 2013. Children with prolonged total or post-tracheotomy length of stay (LOS), less than 12 months of follow-up, or who died during the index hospitalization were excluded. Readmission for a bTARTI (eg, pneumonia, tracheitis) treated with antibiotics, as ascertained by manual chart review, was the outcome variable. We used multivariate logistic regression to identify the independent association between risk factors and hospital readmission for bTARTI within 12 months.
At index hospitalizations for tracheotomy, the median admission age was 5 months (interquartile range [IQR] 2-43 months) and median LOS was 73 days (IQR 43-121 days). Most patients were of Hispanic ethnicity (n = 162, 68%) and were publicly insured (n = 213, 89%). Nearly half (n = 112, 47%) were discharged on positive pressure mechanical ventilation. Many (n = 103, 43%) were admitted for bTARTI within 12 months of discharge. Only Hispanic ethnicity (adjusted odds ratio [AOR] 2.0; 95% confidence interval [CI]: 1.1-3.9; P = 0.03) and acquisition of Pseudomonas aeruginosa between tracheotomy and discharge from index hospitalization (AOR 3.2; 95%CI: 1.2-8.3; P = 0.02) were independently associated with increased odds of bTARTI readmission, while discharge on gastrointestinal pro-motility agents was associated with decreased risk (AOR = 0.4; 95%CI: 0.2-0.8; P = 0.01).
Hispanic ethnicity and post-tracheotomy acquisition of P. aeruginosa during initial hospitalization are associated with bTARTI readmission.
确定气管切开术后出院12个月内因细菌性气管造口术相关呼吸道感染（bTARTI）再次入院的危险因素。
设计/方法：我们对2005年1月1日至2013年6月30日期间接受气管切开术并带气管造口出院的240名儿童进行了一项回顾性队列研究。排除总住院时间或气管切开术后住院时间延长、随访时间少于12个月或在首次住院期间死亡的儿童。通过人工病历审查确定的因bTARTI（如肺炎、气管炎）使用抗生素治疗而再次入院是研究的结局变量。我们使用多因素逻辑回归来确定危险因素与12个月内bTARTI再次入院之间的独立关联。
在气管切开术的首次住院中，入院年龄中位数为5个月（四分位间距[IQR]2 - 43个月），住院时间中位数为73天（IQR 43 - 121天）。大多数患者为西班牙裔（n = 162，68%），并拥有公共保险（n = 213，89%）。近一半（n = 112，47%）在出院时接受正压机械通气。许多患者（n = 103，43%）在出院后12个月内因bTARTI再次入院。只有西班牙裔（调整优势比[AOR]2.0；95%置信区间[CI]：1.1 - 3.9；P = 0.03）以及在气管切开术至首次住院出院期间获得铜绿假单胞菌（AOR 3.2；95%CI：1.2 - 8.3；P = 0.02）与bTARTI再次入院几率增加独立相关，而出院时使用胃肠动力药与风险降低相关（AOR = 0.4；95%CI：0.2 - 0.8；P = 0.01）。
西班牙裔以及首次住院期间气管切开术后获得铜绿假单胞菌与bTARTI再次入院有关。
