Evaluation of Ventilator-Associated Tracheitis in Children with
Pre-Existing Tracheostomies: Organisms and Empiric Coverage
Abstract
Evaluation of Ventilator-Associated Tracheitis in Children with
Pre-Existing Tracheostomies: Organisms and Empiric Coverage Objectives:
This study aims to describe the outcomes, microbiome, and empiric
antimicrobial coverage of ventilator associated tracheitis (VAT) in
pediatric patients with pre-existing tracheostomies. Patients and
Methods: This is a retrospective chart review of pediatric patients with
pre-existing tracheostomies admitted to the Children’s Hospital of
Georgia for initial inpatient treatment for VAT between January 1, 2007
and February 21, 2021. Patients were evaluated for incidence of
ventilator associated pneumonia (VAP), tracheostomy culture results, and
antibiotic choice. Results: Thirty-nine patients were included. Across
all patients evaluated with pre-existing tracheostomies, 60% developed
VAT. There was no difference in the development in VAP between shorter
and longer treatment durations (0 vs 1, p = 1). Patients who developed
Pseudomonas aeruginosa VAT were likely to have a previous culture of P.
aeruginosa (p = 0.003), have a tracheostomy for longer (p = 0.011), and
be older than 1 year of age (p = 0.0002). MRSA VAT was associated with a
previous culture growing MRSA (p= 0.0042). Conclusions: VAT incidence
was higher than what was shown in pediatric patients without
pre-existing tracheostomies but VAP incidence was lower and there was no
difference between treatment groups. VAT should be treated based on
previous cultures and Pseudomonas aeruginosa should be considered as a
causative organism.