Methods
We retrospectively reviewed the medical records of tracheotomised
children who were followed between 1 July 2012 and 31 May 2019 at
Medipol University, Division of Pediatric Pulmonology. Children with
tracheostomy and persistent bacterial colonization who were started on
nebulized antibiotic therapy after a lower respiratory tract infection
were included to the study. Demographic findings, comorbidities,
indications for tracheostomy, age at tracheostomy, duration of
tracheostomy were recorded. The number of oral antibiotic treatment, the
number of hospitalizations, and the length of stay at the intensive care
unit and the bacterial load (determined as the number of colony count
per ml) were recorded from one year before and for 12 months after
initiating nebulized antibiotic treatment. Antimicrobial resistance one
year before and during the nebulized antibiotic treatment were obtained
from patients’ medical records.
Following systemic antibiotic treatment for lower respiratory
infections, patients with persistent bacterial colonization were started
on nebulized antibiotics (gentamycin or colomycin) via inhalation
through tracheostomy by a jet nebulizer according to the antimicrobial
resistance results of tracheal aspirate cultures (gentamycin; 20 mg for
children aged <2 years, 40 mg for children aged 2-8 years, and
80 mg for children aged >8 years old twice daily;
colomycin; one million IU twice daily). Lower respiratory tract
infections were defined as infections with lower airway symptoms (eg,
need for intensified ventilator settings, increased oxygen
supplementation, tachypnea, increased airway
secretions)12.
Tracheal aspirate cultures were routinely obtained every three months
during clinical visits and in the presence of signs of respiratory
infections. Persistent colonization was defined as the isolation of the
same bacteria in three or more consecutive tracheal aspirate cultures
(at least one month apart) in the last year based on studies in the
literature13,14. Nebulized antibiotic treatment was
continued until the patients’ respiratory symptoms improved and the
colony count decreased to 105 CFU/ml or lower in
tracheal aspirate, which is the threshold value for the definition of
infection15,16 .
Effect of current age, age at the time of tracheostomy and the duration
of tracheostomy on the number of oral antibiotic treatment,
hospitalizations, and the length of stay at the intensive care unit were
evaluated. Kidney function tests were recorded to monitor the adverse
effects of nebulized antibiotics.