Results
One hundred and sixty children with tracheostomy were followed at
Medipol University between 2012 and 2019. Persistent bacterial
colonization was present in 57 (36%) of the tracheotomised patients.
Nebulized antibiotic treatment was initiated in 22 patients with
persistent colonization after a lower respiratory tract infection. There
were 15 boys (68%) and 7 girls (32%). The current median age was 75
months (40-115 months). The median age at the time of tracheostomy was 6
months (3-34 months). The median duration of tracheostomy was 32.5
months (19.5-68 months). Fourteen (64%) patients had neuromusculer
disease, four patients (18%) had chronic lung disease as underlying
primary condition. Neurological impairment such as hypotonia was present
in 18 patients (82%). Twenty patients (91%) suffered from concomitant
gastrointestinal problems including swallowing dysfunction,
gastroesophageal reflux and the need for enteral feeding. Patient
characteristics are shown in Table-1. Seventy one percent (n = 15) of
the patients were on home mechanical ventilation. Except for one patient
with cerebral palsy, all patients with neuromusculer disease or
metabolic /syndromic disease were ventilator dependent.
Seventeen (77.3%) patients had P. aeruginosa growth in the
tracheal aspirate cultures, Klebsiella pneumonia grew in three
(13.6%) and Acinetobacter baumanni in two patiens. (9.1%). Five
patients (22.7%) were colonized with more than one bacteria.
Nebulized gentamycin was administered to 14 patients (63.6%) and
colimycin to 8 patients (36.4%). In six patients, gentamycin was
changed to colimycin based on the antimicrobial resistance results. The
median duration of treatment was 3.5 months (3-7.5 months). The median
number of the oral antibiotic courses before and after 12 months of
nebulized antibiotics were 1 (1-3) and 2 (1-3) respectively (p= 0.474).
Following nebulized antibiotic treatment, median number of
hospitalizations decreased from 2 (1-3.5) to 1 (0-1.5) (p=0.04).
Additionally, the median length of stay in the intensive care unit
reduced significantly from 89.5 days (43-82.5) to 25 days (7.75-62.75)
after starting nebulized antibiotics (p = 0.028). Following nebulized
antibiotic treatment colony count also decreased (105CFU/ml (105-106) vs.6x104 CFU/ml
(104-105); p=0.003). The median time
to first bacterial growth was 3.7 month (1.17-6.62 months) after the
discontuniation of the nebulized antibiotics.
The median colony count at the 12th month after the start of the
nebulized antibiotics reduced significantly compared to prior to
intervention (105 CFU/ml vs 104CFU/ml; p=0.02). Additionally, the number of patients with a colony
count of >105 CFU/ml decreased from
eighteen to six at the end of the study period (p=0.07) (Table-2). There
were no significant correlations between current age, age at the time of
tracheostomy, duration of tracheostomy and study outcomes
(p>0.05).
Gentamycin resistance was observed in six patients (28.5%) during
treatment. No resistance was observed with nebulized colimycin
treatment. None of the patients reported respiratory adverse events
including chest pain, dyspnea, bronchospasm during nebulized antibiotic
treatment. Renal function tests were within normal limits during the
nebulized antibitic treatment in all patients.
During follow-up, 3 patients were decannulated (14%). Two patients had
congenital heart disease and one patient had chronic lung disease.
During follow-up, 4 patients died due to their underlying diseases
(18%).