Suspected respiratory tract infection in the tracheostomized child: the pediatric pulmonologist's approach.

STUDY

OBJECTIVES

It is difficult to determine, in the child with a long-term tracheostomy, when bacterial airway colonization has progressed to a respiratory infection requiring antibiotic treatment. Our aim was to investigate whether there is a consensus regarding this and related chronic care issues among clinicians treating these patients.

DESIGN AND

SETTING

A questionnaire asking about practices regarding use of tracheal aspirate cultures and antibiotics was distributed to 47 pediatric pulmonary centers.

PARTICIPANTS

Individuals representing 34 centers (72%), caring for 10 to 400 patients, responded.

INTERVENTIONS: None.

RESULTS

At 65% of centers, management is variable, dependent on the patient's underlying condition. The most common indications to obtain a culture were change in secretions (91%) or fever without an obvious source (21 centers). Indications to treat with antibiotics included many leukocytes in secretions (21 centers) or a respiratory illness (18 centers). When treating, 97% prescribe antibiotics empirically, most often enterally; nine centers use inhaled antibiotics. In most centers (79%), management is often done by telephone.

CONCLUSIONS

Although pediatric pulmonologists tend to have similar approaches to assessment and management of suspected respiratory tract infections in tracheostomized children, no clear consensus exists, and much of current practice is empirical. To optimize care of these patients, studies should be conducted to develop criteria to objectively differentiate bacterial airway "colonization" from "infection."