Biosciences Institute, William Leech Building, Newcastle University, Newcastle Upon Tyne, UK.
Department of Paediatric Otolaryngology, Great North Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
Pediatr Pulmonol. 2024 Feb;59(2):251-259. doi: 10.1002/ppul.26766. Epub 2023 Nov 27.
Tracheostomies are indicated in children to facilitate long-term ventilatory support, aid in the management of secretions, or manage upper airway obstruction. Children with tracheostomies often experience ongoing airway complications, of which respiratory tract infections are common. They subsequently receive frequent courses of broad-spectrum antimicrobials for the prevention or treatment of respiratory tract infections. However, there is little consensus in practice with regard to the indication for treatment/prophylactic antimicrobial use, choice of antimicrobial, route of administration, or duration of treatment between different centers. Routine antibiotic use is associated with adverse effects and an increased risk of antimicrobial resistance. Tracheal cultures are commonly obtained from pediatric tracheostomy patients, with the aim of helping guide antimicrobial therapy choice. However, a positive culture alone is not diagnostic of infection and the role of routine surveillance cultures remains contentious. Inhaled antimicrobial use is also widespread in the management of tracheostomy-associated infections; this is largely based on the theoretical benefits of higher airway antibiotic concentrations. The role of prophylactic inhaled antimicrobial use for tracheostomy-associated infections remains largely unproven. This systematic review summarizes the current evidence base for antimicrobial selection, duration, and administration route in pediatric tracheostomy-associated infections. It also highlights significant variation in practice between centers and the urgent need for further prospective evidence to guide the management of these vulnerable patients.
气管切开术适用于儿童，以方便长期通气支持、帮助管理分泌物或治疗上呼吸道阻塞。有气管切开术的儿童经常出现持续的气道并发症，其中呼吸道感染很常见。因此，他们经常接受广谱抗生素的频繁疗程，以预防或治疗呼吸道感染。然而，不同中心之间在治疗/预防性使用抗生素的指征、抗生素的选择、给药途径或治疗持续时间方面，几乎没有共识。常规使用抗生素会引起不良反应，并增加对抗生素耐药性的风险。气管切开术患者通常会进行气管培养，以帮助指导抗生素治疗选择。然而，单纯的阳性培养并不能诊断感染，常规监测培养的作用仍存在争议。吸入性抗生素在治疗气管切开相关感染中的应用也很广泛；这主要基于提高气道抗生素浓度的理论优势。预防性使用吸入性抗生素治疗气管切开相关感染的作用在很大程度上尚未得到证实。本系统评价总结了儿科气管切开相关感染中抗生素选择、持续时间和给药途径的现有证据基础。它还突出了中心之间实践的显著差异，迫切需要进一步的前瞻性证据来指导这些脆弱患者的管理。
