Abstract
Background
Up to 90% of children develop Pseudomonas aeruginosa (Pa)-positive respiratory cultures after tracheotomy.
Objective
To identify the factors associated with chronic Pa-positive respiratory cultures in the first 2 years after tracheotomy.
Methods
We conducted a retrospective cohort study of 210 children ≤ 18 years old who underwent tracheotomy at a single freestanding children’s hospital that had two or more years of respiratory cultures post-tracheotomy available for analysis. We conducted multivariable logistic regression to test the association between demographic and clinical factors to our primary outcome of chronic Pa infection, defined as > 75% of respiratory cultures positive for Pa in the first 2 years after tracheotomy.
Results
Of the primarily male (61%), Hispanic (68%), and publicly insured (88%) cohort, 18% (n = 37) developed chronic Pa-positive respiratory cultures in the first 2 years. On multivariable logistic regression, pre-tracheotomy Pa-positive respiratory culture (aOR 11.3; 95% CI 4–1.5) and discharge on beta agonist (aOR 6.3; 95% CI 1.1–36.8) were independently associated with chronic Pa-positive respiratory cultures, while discharge on chronic mechanical ventilation was associated with decreased odds (aOR 0.3; 95% CI 0.1–0.7). On sensitivity analysis examining those without a pre-tracheotomy Pa-positive respiratory culture, discharge on MV continued to be associated with decreased odds of chronic Pa (aOR 0.1; 95% CI 0.02–0.4) and three other variables (male gender, chronic lung disease, and discharge on inhaled corticosteroids) were associated with increased odds of chronic Pa.
Conclusion
Because pre-tracheotomy Pa growth on respiratory culture is associated with post-tracheotomy chronic Pa-positive respiratory cultures, future research should examine pre-tracheotomy Pa eradication or suppression protocols.
Similar content being viewed by others
References
Zhu H, Das P, Roberson DW, Jang J, Skinner ML, Paine M, Yuan J, Berry J (2015) Hospitalizations in children with preexisting tracheostomy: a national perspective. Laryngoscope 125(2):462–468
Russell CJ, Mamey MR, Koh JY, Schrager SM, Neely MN, Wu S (2018) Length of stay and hospital revisit after bacterial tracheostomy-associated respiratory tract infection hospitalizations. Hosp Pediatr 8(2):72–80. https://doi.org/10.1542/hpeds.2017-0106
Yu H, Mamey MR, Russell CJ (2017) Factors associated with 30-day all-cause hospital readmission after tracheotomy in pediatric patients. Int J Pediatr Otorhinolaryngol 103:137–141
Russell CJ, Thurm C, Hall M, Simon TD, Neely MN, Berry JG (2018) Risk factors for hospitalizations due to bacterial respiratory tract infections after tracheotomy. Pediatr Pulmonol 53:349–357
Morar P, Singh V, Makura Z, Jones A, Baines P, Selby A, Sarginson R, Hughes J, van Saene R (2002) Differing pathways of lower airway colonization and infection according to mode of ventilation (endotracheal vs tracheotomy). Arch Otolaryngol Head Neck Surg 128(9):1061–1066
McCaleb R, Warren RH, Willis D, Maples HD, Bai S, O’Brien CE (2016) Description of respiratory microbiology of children with long-term tracheostomies. Respir Care 61(4):447–452
Gerdung CA, Tsang A, Yasseen AS 3rd, Armstrong K, McMillan HJ, Kovesi T (2016) Association between chronic aspiration and chronic airway infection with Pseudomonas aeruginosa and other gram-negative bacteria in children with cerebral palsy. Lung 194(2):307–314
Ashkenazi-Hoffnung L, Ari A, Bilavsky E, Scheuerman O, Amir J, Prais D (2016) Pseudomonas aeruginosa identified as a key pathogen in hospitalised children with aspiration pneumonia and a high aspiration risk. Acta Paediatr 105(12):e588–e592
Morar P, Singh V, Makura Z, Jones AS, Baines PB, Selby A, Sarginson R, Hughes J, van Saene R (2002) Oropharyngeal carriage and lower airway colonisation/infection in 45 tracheotomised children. Thorax 57(12):1015–1020
Russell CJ, Simon TD, Mamey MR, Newth CJL, Neely MN (2017) Pseudomonas aeruginosa and post-tracheotomy bacterial respiratory tract infection readmissions. Pediatr Pulmonol 52(9):1212–1218
Mayer-Hamblett N, Kronmal RA, Gibson RL, Rosenfeld M, Retsch-Bogart G, Treggiari MM, Burns JL, Khan U, Ramsey BW (2012) Initial Pseudomonas aeruginosa treatment failure is associated with exacerbations in cystic fibrosis. Pediatr Pulmonol 47(2):125–134
Zemanick ET, Emerson J, Thompson V, McNamara S, Morgan W, Gibson RL, Rosenfeld M (2015) Clinical outcomes after initial pseudomonas acquisition in cystic fibrosis. Pediatr Pulmonol 50(1):42–48
Berry JG, Graham DA, Graham RJ, Zhou J, Putney HL, O'Brien JE, Roberson DW, Goldmann DA (2009) Predictors of clinical outcomes and hospital resource use of children after tracheotomy. Pediatrics 124(2):563–572
Berry JG, Graham RJ, Roberson DW, Rhein L, Graham DA, Zhou J, O'Brien J, Putney H, Goldmann DA (2010) Patient characteristics associated with in-hospital mortality in children following tracheotomy. Arch Dis Child 95(9):703–710
Heltshe SL, Khan U, Beckett V, Baines A, Emerson J, Sanders DB, Gibson RL, Morgan W, Rosenfeld M (2017) Longitudinal development of initial, chronic and mucoid Pseudomonas aeruginosa infection in young children with cystic fibrosis. J Cyst Fibros 17:341–347
Pennington A, Dobies CG (2014) PHIS description when referenced as data source. https://bit.ly/1tEESzM. Accessed 1 Aug 2014
Lewis CW, Carron JD, Perkins JA, Sie KC, Feudtner C (2003) Tracheotomy in pediatric patients: a national perspective. Arch Otolaryngol Head Neck Surg 129(5):523–529
Coraux C, Kileztky C, Polette M, Hinnrasky J, Zahm JM, Devillier P, De Bentzmann S, Puchelle E (2004) Airway epithelial integrity is protected by a long-acting beta2-adrenergic receptor agonist. Am J Respir Cell Mol Biol 30(5):605–612
Dowling RB, Rayner CF, Rutman A, Jackson AD, Kanthakumar K, Dewar A, Taylor GW, Cole PJ, Johnson M, Wilson R (1997) Effect of salmeterol on Pseudomonas aeruginosa infection of respiratory mucosa. Am J Respir Crit Care Med 155(1):327–336
Dowling RB, Johnson M, Cole PJ, Wilson R (1999) Effect of fluticasone propionate and salmeterol on Pseudomonas aeruginosa infection of the respiratory mucosa in vitro. Eur Respir J 14(2):363–369
Dowling RB, Johnson M, Cole PJ, Wilson R (1998) Effect of salmeterol on Haemophilus influenzae infection of respiratory mucosa in vitro. Eur Respir J 11(1):86–90
Gross CA, Bowler RP, Green RM, Weinberger AR, Schnell C, Chu HW (2010) beta2-agonists promote host defense against bacterial infection in primary human bronchial epithelial cells. BMC Pulm Med 10:30
Maris NA, Florquin S, C. van't Veer, A.F. de Vos, W. Buurman, H.M. Jansen, T. van der Poll, (2006) Inhalation of beta 2 agonists impairs the clearance of nontypable Haemophilus influenzae from the murine respiratory tract. Respir Res 7:57
Bansal V, Mangi MA, Johnson MM, Festic E (2015) Inhaled corticosteroids and incident pneumonia in patients with asthma: Systematic review and meta-analysis. Acta Med Acad 44(2):135–158
Festic E, Bansal V, Gupta E, Scanlon PD (2016) Association of inhaled corticosteroids with incident pneumonia and mortality in COPD patients; systematic review and meta-analysis. Copd 13(3):312–326
Cazeiro C, Silva C, Mayer S, Mariany V, Wainwright CE, Zhang L (2017) Inhaled corticosteroids and respiratory infections in children with asthma: a meta-analysis. Pediatrics 139(3):e20163271
Perez-Losada M, Graham RJ, Coquillette M, Jafarey A, Castro-Nallar E, Aira M, Hoptay C, Freishtat RJ, Mansbach JM (2018) Tracheal microbiota in patients with a tracheostomy before, during and after an acute respiratory infection. Pediatr Infect Dis J 37(11):e269–e271
Perez-Losada M, Graham RJ, Coquillette M, Jafarey A, Castro-Nallar E, Aira M, Freishtat RJ, Mansbach JM (2017) The temporal dynamics of the tracheal microbiome in tracheostomised patients with and without lower respiratory infections. PLoS ONE 12(8):e0182520
Russell CJ, Mack WJ, Schrager SM, Wu S (2017) Care variations and outcomes for children hospitalized with bacterial tracheostomy-associated respiratory infections. Hosp Pediatr 7(1):16–23
Morar P, Makura Z, Jones A, Baines P, Selby A, Hughes J, van Saene R (2000) Topical antibiotics on tracheostoma prevents exogenous colonization and infection of lower airways in children. Chest 117(2):513–518
Acknowledgements
The authors have no financial relationships relevant to this article to disclose.
Funding
Dr. Russell was a KL2 Scholar awarded under the KL2 Mentoring Research Career Development Award through Southern California Clinical and Translational Science Institute at University of Southern California, Keck School of Medicine. The project described was supported by the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through Grant Award Number KL2TR000131. The content is solely the responsibility of the author(s) and does not necessarily represent the official view of NIH.
Author information
Authors and Affiliations
Contributions
Dr. Russell conceptualized and designed the study, conducted the statistical analyses, drafted the initial manuscript, and approved the final manuscript as submitted. Drs. Simon and Neely assisted in study design, reviewed and critically revised the manuscript, and approved the final manuscript as submitted.
Corresponding author
Ethics declarations
Conflict of interest:
The authors have no conflicts of interest relevant to this article to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Russell, C.J., Simon, T.D. & Neely, M.N. Development of Chronic Pseudomonas aeruginosa-Positive Respiratory Cultures in Children with Tracheostomy. Lung 197, 811–817 (2019). https://doi.org/10.1007/s00408-019-00285-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00408-019-00285-6