Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Elizabeth Monsees PhD, MBA, RN, CIC, FAPIC
Start Date
3-5-2022 11:30 AM
End Date
3-5-2022 1:30 PM
Presentation Type
Poster Presentation
Description
Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.
Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.
Methods: A retrospective chart review occurred on 15 patients in the PICU between 2018-2019 with ≥ 2 TAs obtained during their hospital encounter. The following was collected on each TA from the medical record: microbiologic profile with susceptibilities, antibiotic exposure, and clinical data summarizing patient condition at the time of TA collection. Descriptive statistics established the frequency and time between initial and repeat TAs, reason for collection, antibiotic exposure, and frequency an MDRO was isolated.
Results: Most patients were < 5 years of age (N=14; 94%), male (N=13; 87%), and were admitted to the medical ICU service (N=8, 53%). Fever (46%) was the most common reason for TA collection followed by vital sign changes, then secretion burden (34% and 32% respectively). The median length of stay was 117 days [IQR 33,210]. The median number of TAs per hospitalization was 4 [2.5, 8]. The median days between cultures was 10 [4, 26 days] (Figure 1). A total of 133 organisms were detected on these cultures, with Pseudomonas aeruginosa (n=32), Methicillin-susceptible Staphylococcus aureus (n=16), and Klebsiella oxytoca (n=11) comprising the top pathogens (Figure 2). Eleven of the 15 patients (73.3%) had the same organism detected on 2 or more separate cultures. A total of 616 antibiotic days were prescribed for these patients with 149 (24%) antibiotic days prescribed for the TA. Six (40%) patients had a multi-drug resistant organism isolated after a median of 14.5 antibiotic days [11.75, 37.5 days].
Conclusion: This study identified multiple TAs occur during a hospital stay with the same pathogen cultured often on repeat samples. Development of resistance is common and only a minority of TAs are directly treated with antibiotics. These data provide an opportunity to further explore clinical criteria to maximize the impact of TA cultures in the PICU.
Additional Files
Repeat Tracheal Aspirates in Pediatric Intensive Care Patients.pdf (231 kB)Abstract
TDIFF Boxplot.tif (3071 kB)
Figure 1
Organism BG.tif (3071 kB)
Figure 2
Included in
Higher Education and Teaching Commons, Infectious Disease Commons, Medical Education Commons, Pediatrics Commons, Science and Mathematics Education Commons
Repeat Tracheal Aspirates in Pediatric Intensive Care Patients: Understanding Clinical Application
Background: Tracheal aspirate cultures (TA) are regularly obtained in the pediatric intensive care unit (PICU) when clinical changes in intubated or tracheostomy dependent children occur. Positive TA results are often unable to distinguish infection from colonization. There is no data describing the frequency and impact of repeated TAs on patients in the PICU.
Goal: Our objectives were to describe the frequency of repeated TAs in PICU children and emergence of multidrug resistant organisms (MDRO), identify bacterial profile of TAs, and examine antibiotic prescribing patterns related to these cultures.
Methods: A retrospective chart review occurred on 15 patients in the PICU between 2018-2019 with ≥ 2 TAs obtained during their hospital encounter. The following was collected on each TA from the medical record: microbiologic profile with susceptibilities, antibiotic exposure, and clinical data summarizing patient condition at the time of TA collection. Descriptive statistics established the frequency and time between initial and repeat TAs, reason for collection, antibiotic exposure, and frequency an MDRO was isolated.
Results: Most patients were < 5 years of age (N=14; 94%), male (N=13; 87%), and were admitted to the medical ICU service (N=8, 53%). Fever (46%) was the most common reason for TA collection followed by vital sign changes, then secretion burden (34% and 32% respectively). The median length of stay was 117 days [IQR 33,210]. The median number of TAs per hospitalization was 4 [2.5, 8]. The median days between cultures was 10 [4, 26 days] (Figure 1). A total of 133 organisms were detected on these cultures, with Pseudomonas aeruginosa (n=32), Methicillin-susceptible Staphylococcus aureus (n=16), and Klebsiella oxytoca (n=11) comprising the top pathogens (Figure 2). Eleven of the 15 patients (73.3%) had the same organism detected on 2 or more separate cultures. A total of 616 antibiotic days were prescribed for these patients with 149 (24%) antibiotic days prescribed for the TA. Six (40%) patients had a multi-drug resistant organism isolated after a median of 14.5 antibiotic days [11.75, 37.5 days].
Conclusion: This study identified multiple TAs occur during a hospital stay with the same pathogen cultured often on repeat samples. Development of resistance is common and only a minority of TAs are directly treated with antibiotics. These data provide an opportunity to further explore clinical criteria to maximize the impact of TA cultures in the PICU.
