Incidence of bacterial tracheitis in pediatric patients with artificial airways
Background: Bacterial tracheitis is an invasive exudative infection that affects the soft tissue of the trachea. Although it is an uncommon disease in healthy children, pediatric patients with long-term tracheostomy tubes are at increased risk of life-threatening infection since these tubes cause irritation of the mucosa thereby disrupting the innate mucosal immunity. Furthermore, tracheostomy tubes serve as portal of entry for bacteria.^ Objectives: To (i) examine the incidence rate of bacterial tracheitis in pediatric patient with long-term tracheostomy, (ii) determine the pathogen most commonly cultured in tracheal aspirate and the antibiotic therapy involved, (iii) estimate the percentage of complicated cases (requiring ER/hospitalization) and determine the risk factors associated with bacterial tracheitis.^ Methods: A retrospective chart review was conducted with all patients 18 years old and younger who attended the pediatric clinic at the University of Texas Physician Building and who had a tracheostomy tube before October 1, 2013. Descriptive statistical analysis was performed using median for non-normally distributed data and means for normally distributed data. The Fisher Exact or Chi-square test was used to compare categorical data, while the Mann-Whitney rank sum test was used to compare the distributions of continuous data. In addition, we used both logistic model and a mixed regression model to search for any associations between all variables.^ Results: Incidence rate of tracheitis was 0.67 (CI 0.59-0.81). The median number of episodes was two [IQR 1-4] per year. There was a low to moderate correlation between age and time with tracheostomy and number of episodes. The bacteria most commonly found in the tracheal aspirate was Pseudomonas aeruginosa and the antibiotic most commonly prescribed was tobramycin. One-third of the cases resulted in ER visit and risk factors associated with bacterial tracheitis in the patient population studied are mechanical ventilation and being of Hispanic descent.^ Conclusion: Almost 70% of our patient population had at least one episode of tracheitis, with most having three or less episodes per year. Bacterial tracheitis is a cause of high morbidity among pediatric patients with a long-term tracheostomy tube.^
Gomez-Rubio, Ana Maria, "Incidence of bacterial tracheitis in pediatric patients with artificial airways" (2015). Texas Medical Center Dissertations (via ProQuest). AAI1604155.