Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.
Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei, Taiwan.
J Microbiol Immunol Infect. 2020 Apr;53(2):315-320. doi: 10.1016/j.jmii.2018.07.002. Epub 2018 Aug 9.
Children with tracheostomy are at increased risk for respiratory tract infections, yet the risk involved in tracheostomy related infections is unclear.
We conducted a retrospective review of the medical records of children who underwent tracheostomy between January 2002 and December 2016 at a teaching hospital in Taipei. Demographics, underlying disease, indication for tracheostomy, laboratory data and management, and long-term outcome data were collected. Infection episodes were grouped into definite, possible, non-bacterial pneumonia, and local infection groups.
Ninety patients were enrolled. Forty-two (46.7%) patients had infections that required hospitalization. Definite bacterial pneumonia accounted for 12 (8.5%) episodes, 113 episodes (80.1%) were possible bacterial pneumonia, 12 (8.5%) were non-bacterial pneumonia, and 4 (2.8%) were local infections. Patients with definite and possible bacterial pneumonia were found to have a longer hospital duration than patients with non-bacterial pneumonia (p=0.024), with mean hospitalization stays of 8.83±5.59 days and 5.67±2.55 days, respectively. The median duration from tracheostomy to bacterial pneumonia was 1.78 years (range, 0.04- 11.38) whereas for the non-bacterial pneumonia group it was 0.57 years (range, 0.04-6.61). Cerebral palsy (CP) (adjusted odds ratio [AOR] 3.65; 95% confidence interval [CI]: 1.11-11.99; p=0.033) and gastroesophageal reflux disease (GERD) (AOR 2.84; 95% CI: 1.09-7.38; p=0.033) were independently associated with respiratory tract infections in these children.
In this study, CP and GERD were associated with infections in children with tracheostomy. Bacterial and non-bacterial pneumonia are difficult to differentiate clinically which may lead to unnecessary antibiotics use.
气管切开术患儿发生呼吸道感染的风险增加，但气管切开术相关感染的风险尚不清楚。
我们对 2002 年 1 月至 2016 年 12 月在台北一家教学医院行气管切开术的患儿的病历进行了回顾性分析。收集了患儿的人口统计学、基础疾病、气管切开术指征、实验室数据和管理以及长期预后数据。将感染发作分为明确的、可能的、非细菌性肺炎和局部感染组。
共纳入 90 例患儿。42 例（46.7%）患儿发生需要住院的感染。明确的细菌性肺炎占 12 例（8.5%），113 例（80.1%）为可能的细菌性肺炎，12 例（8.5%）为非细菌性肺炎，4 例（2.8%）为局部感染。与非细菌性肺炎患者相比，明确和可能的细菌性肺炎患者的住院时间更长（p=0.024），分别为 8.83±5.59 天和 5.67±2.55 天。从气管切开到细菌性肺炎的中位时间为 1.78 年（范围：0.04-11.38），而非细菌性肺炎组为 0.57 年（范围：0.04-6.61）。脑瘫（CP）（调整后比值比 [AOR] 3.65；95%置信区间 [CI]：1.11-11.99；p=0.033）和胃食管反流病（GERD）（AOR 2.84；95% CI：1.09-7.38；p=0.033）与这些患儿的呼吸道感染独立相关。
在这项研究中，CP 和 GERD 与气管切开术患儿的感染有关。细菌性和非细菌性肺炎在临床上难以区分，这可能导致不必要的抗生素使用。
