Division of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA.
Division of Pediatric Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri, USA.
Pediatr Pulmonol. 2023 Jan;58(1):26-34. doi: 10.1002/ppul.26152. Epub 2022 Sep 23.
OBJECTIVE/BACKGROUND: Children with tracheostomies are at an increased risk of bacterial respiratory tract infections. Infections caused by multidrug-resistant organisms (MDROs) are more difficult to treat and can result in severe complications. This study aimed to investigate the risk factors and sequelae of MDRO positivity in tracheostomy and chronic ventilator-dependent children.
We performed a retrospective chart review of 75 tracheostomy and chronic ventilator-dependent children at St. Louis Children's Hospital. Data on demographics, respiratory cultures, hospitalizations, emergency department (ED) visits, and antibiotic usage were collected. We determined the frequency of MDRO positivity and compared the number of hospitalizations, number of ED visits, and antibiotic usage in patients with and without MDRO-positive cultures. Patient clinical variables were analyzed before and after MDRO acquisition.
We found 75.7% (56/74) of our participants had an MDRO-positive culture, with methicillin-resistant Staphylococcus aureus (MRSA, n = 36, 64%) and Pseudomonas aeruginosa (n = 8, 14%) being the most commonly detected organisms. Participants with a greater number of annual nonpulmonary admissions (odds ratio [OR] = 1.99, 95% confidence interval [CI] (1.21-3.29), p = 0.008], inpatient antibiotic courses [OR = 1.27, 95% CI (1.07-1.50), p = 0.006], total antibiotic courses [OR = 1.26, 95% CI (1.08-1.48), p = 0.004], and chronic antibiotic use [OR = 2.31, 95% CI (1.12-4.74), p = 0.03] were at an increased risk for MDRO positivity. Those who were MDRO-positive had more pulmonary admissions following MDRO acquisition compared those who were MDRO-negative [p = 0.005] but not more antibiotic usage or ED visits.
Frequent antibiotic usage and hospitalizations increase the risk of MDRO acquisition in children with tracheostomies and ventilator-dependence. Further antibiotic stewardship may help prevent resistant infections in technology-dependent children.
目的/背景：气管造口术和慢性呼吸机依赖的儿童发生细菌呼吸道感染的风险增加。由多药耐药菌（MDRO）引起的感染更难治疗，并且可能导致严重的并发症。本研究旨在探讨气管造口术和慢性呼吸机依赖儿童 MDRO 阳性的危险因素和后果。
我们对圣路易斯儿童医院的 75 例气管造口术和慢性呼吸机依赖的儿童进行了回顾性图表审查。收集了人口统计学、呼吸道培养、住院、急诊就诊和抗生素使用的数据。我们确定了 MDRO 阳性的频率，并比较了 MDRO 阳性培养患者和无 MDRO 阳性培养患者的住院次数、急诊就诊次数和抗生素使用情况。在获得 MDRO 前后分析了患者的临床变量。
我们发现 75.7%（56/74）的参与者的培养物呈 MDRO 阳性，耐甲氧西林金黄色葡萄球菌（MRSA，n=36，64%）和铜绿假单胞菌（n=8，14%）是最常检测到的病原体。每年非肺部住院次数较多的患者（比值比[OR] = 1.99，95%置信区间[CI]（1.21-3.29），p = 0.008）、住院期间抗生素疗程（OR = 1.27，95%CI（1.07-1.50），p = 0.006）、总抗生素疗程（OR = 1.26，95%CI（1.08-1.48），p = 0.004）和慢性抗生素使用（OR = 2.31，95%CI（1.12-4.74），p = 0.03）的风险增加。与 MDRO 阴性患者相比，获得 MDRO 后的 MDRO 阳性患者的肺部住院次数更多[P=0.005]，但抗生素使用或急诊就诊次数没有增加。
气管造口术和呼吸机依赖的儿童频繁使用抗生素和住院会增加获得 MDRO 的风险。进一步的抗生素管理可能有助于预防依赖技术的儿童发生耐药感染。
